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Fill and Sign the Fillable Online Michigan Statutory Uniform Donor Card for

Fill and Sign the Fillable Online Michigan Statutory Uniform Donor Card for

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DONATION PURSUANT TO THE MICHIGAN UNIFORM ANATOMICAL GIFT ACT (Michigan Consolidated Laws, 333.10104 to 333.10109) In the hope that I may help others, I hereby make this anatomical gift if medically acceptable, to take effect upon my death. The words and marks below indicate my desires.I give: (a) . any needed organs or physical parts (b) . only the following organs or physical parts ____________________________________Specify the organ(s) or physical part(s)For the purposes of transplantation, therapy, medical research or education; (c) . my body for anatomical study if needed. Limitations or special wishes, if any: ____________________________________Signed this day of __________, ____________________, 20 _____, Signed by the donor and the following 2 witnesses in the presence of each other: _________________________________ ____________________________________ Signature of donor Date of birth of donor _________________________________ ____________________________________ Date signed City and State _________________________________ ____________________________________ Witness Witness This is a legal document under the Michigan Uniform Anatomical Gift Act, Michigan Consolidated Laws, 333.10104 to 333.10109.

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