Pioneers in Internet Technology for your legal needs!
CERTIFICATE
OF AUTHORIZATION FOR POST-MORTEM STUDY AND EXAMINATION
OR REMOVAL OF TISSUES OR ORGANS In the event of my death, I donate
the following part(s) of my body for the purposes identified in Mississippi
Code Annotated 41-39-31 to 41-39-51.
Please Complete All Applicable
Sections
Select County:
Your Name:
Address:
City:
State:
Zip:
Phone:
Email:
Date of
Birth:
U.S. Citizen? Yes
No
Other Names:
Are you known by any other names.
Gender:
Male
Female
Name of
Spouse:
Provide the Full name of your spouse.
m
Power of Attorney
Donee:
Donate
my:
The donee specified above, for therapy
or transplantation needed by him or her, I do hereby donate my
Said purpose to:
Remove and preserve:
I hereby authorize a licensed physician,
surgeon or certified technician or the state anatomy board to remove and
preserve for use my
Said purpose to:
h
Optional Items
Other Provisions desired:
Adams & Edens offers quality legal services through your home or office computer.
