Alaska Statutes.
Title 13. Decedents' Estates, Guardianships, Transfers, and Trusts.
Chapter 52. Health Care Decisions Act
Section 190. Optional Form For Anatomical Gift By Another Person.
previous: Section 180. Making, Revoking, and Objecting to Anatomical Gifts By Others.
next: Section 200. Routine Inquiry and Required Request; Search and Notification.

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



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

body of                                                                


(name of decedent)                                                     

who died on                                                            





 (place) (city)                                                         




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)                                                  

All content © 2008 by Touch N' Go/Bright Solutions, Inc.

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.