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Rhode Island Funeral Planning Agent Designation Form I as a principal as defined in R.I. Gen.Law 5-33. 3-2 b do hereby name and designate please print as my primary funeral planning agent or if he/she is unwilling or incapable please print as my alternate funeral planning agent who shall have the sole responsibility and authority to make any and all arrangements and decisions regarding my funeral preparation and planning burial or disposition of my remains including cremation upon my death pursuant to the provisions of Chapters 33. 2 and 33. 3 of Title 5 of the Rhode Island General Laws. By signing this document the aforementioned agent s agree to ensure payment for all outstanding expenses related to my funeral* The agent further certifies that if he/she is a non-relative to the agent then he/she is the only non-relative for whom the agent is serving as a funeral planning agent. This document shall revoke and make null and void any and all previous designations of a funeral planning agent. Printed Name of Principal Date Signature of Principal Printed Address of Principal Signature of Alternate Agent if applicable State of County of On this day of 20 before me the undersigned notary public personally appeared please print personally known to me or proved to me through satisfactory evidence of identification which was this document as the Principal and acknowledged to me that he/she signed its voluntarily and for its stated purpose. Notary Signature and Seal of Notary Printed Notary Name Commission Identification Number Commission Expires Pursuant to Chapter 33. 3 of Title 5 of the Rhode Island General Laws any individual who is at least eighteen 18 years of age and of sound mind is allowed to designate a primary funeral planning agent and an alternate agent if desirable who has the authority and responsibility to make all funeral arrangements as described in R*I. 3-2 b do hereby name and designate please print as my primary funeral planning agent or if he/she is unwilling or incapable please print as my alternate funeral planning agent who shall have the sole responsibility and authority to make any and all arrangements and decisions regarding my funeral preparation and planning burial or disposition of my remains including cremation upon my death pursuant to the provisions of Chapters 33. 2 and 33. 3 of Title 5 of the Rhode Island General Laws. By signing this document the aforementioned agent s agree to ensure payment for all outstanding expenses related to my funeral* The agent further certifies that if he/she is a non-relative to the agent then he/she is the only non-relative for whom the agent is serving as a funeral planning agent. 2 and 33. 3 of Title 5 of the Rhode Island General Laws. By signing this document the aforementioned agent s agree to ensure payment for all outstanding expenses related to my funeral* The agent further certifies that if he/she is a non-relative to the agent then he/she is the only non-relative for whom the agent is serving as a funeral planning agent. This document shall revoke and make null and void any and all previous designations of a funeral planning agent.