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Alaska Statutes.

Title 13. Estates, Guardianships, Transfers, Trusts.

Chapter 52. Health Care Decisions Act

Section 190. Optional Form For Anatomical Gift By Another Person.

AS 13.52.190. Optional Form For Anatomical Gift By Another Person.

ANATOMICAL GIFT BY NEXT OF KIN,

GUARDIAN, AGENT, OR SURROGATE                                          

Under AS 13.52.170 - 13.52.280, I make this anatomical gift from the

body of                                                                

____________________________________________________________________ (name of decedent)                                                     

who died on                                                            

____________________________________________________________________ (date)                                                                 

at                                                                     

____________________________________________________________________ (place) (city)                                                         

in                                                                     

____________________________________________________________________ (state)                                                                

The marks in the appropriate squares and the words filled into the     

blanks below indicate my relationship to the decedent and my wishes

respecting the gift.                                                   

I survive the decedent as ( ) spouse; ( ) adult son or daughter; ( ) parent; ( ) adult brother or sister; ( ) grandparent; or I am the decedent's ( ) agent under AS 13.52 or ( ) surrogate under AS 13.52. I hereby give (check boxes applicable):                                

( ) any needed organs, tissues, or parts; ( ) the following organs, tissues, or parts only: __________________________________________________________________ ;

( ) the following purposes only: __________________________________________________________________ . ____________________________________________________________________ (date) (signature of survivor)                                         

(address of survivor)                                                  

Note to HTML Version:

This version of the Alaska Statutes is current through December, 2004. The Alaska Statutes were automatically converted to HTML from a plain text format. Every effort has been made to ensure their accuracy, but this can not be guaranteed. If it is critical that the precise terms of the Alaska Statutes be known, it is recommended that more formal sources be consulted. For statutes adopted after the effective date of these statutes, see, Alaska State Legislature If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful.

Last modified 9/3/2005