Indiana Code Title 29. Probate § 29-2-19-13

Sec. 13. The following is the funeral planning declaration form:

FUNERAL PLANNING DECLARATION

Declaration made this_____day of_______(month, year).  I,__________, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known my instructions concerning funeral services, ceremonies, and the disposition of my remains after my death.

I hereby declare and direct that after my death__________________(name of designee) shall, as my designee, carry out the instructions that are set forth in this declaration.  If my designee is unwilling or unable to act, I nominate____________as an alternate designee.

I hereby declare and direct that after my death the following actions be taken (indicate your choice by initialing or making your mark before signing this declaration):

It is my intention that this declaration be honored by my family and others as the final expression of my intentions concerning my funeral and the disposition of my body after my death.  I understand the full import of this declaration.

The declarant is personally known to me, and I believe the declarant to be of sound mind.  I did not sign the declarant's signature above for or at the direction of the declarant.  I am not a parent, spouse, or child of the declarant.  I am not entitled to any part of the declarant's estate.  I am competent and at least eighteen (18) years of age.

Witness_______________Date__________

Witness_______________Date__________