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GUARDIAN, AGENT, OR SURROGATE
ANATOMICAL GIFT BY NEXT OF KIN,
Under AS 13.52.170 - 13.52.280, I make this anatomical gift from the
(name of decedent)
who died on
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)
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Note to HTML Version:
This version of the Alaska Statutes is current through December, 2007. 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.