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Fill and Sign the Uniform Anatomical Gift Act Nj Sharing Network

Fill and Sign the Uniform Anatomical Gift Act Nj Sharing Network

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Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

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DONATION PURSUANT TO THE REVISED UNIFORM ANATOMICAL GIFT ACT (Hawaii Revised Statutes 327-5 et seq.) In the event of my death, I donate the following part(s) of my body for the purposes identified in Hawaii Revised Statutes 327-11.TISSUE: Eyes Bone and connective tissue Skin Heart Other: ___________________________________________________________Limitations: ___________________________________________________________ORGAN: Heart Kidney(s) Liver Lung(s) Pancreas Other: ___________________________________________________________Limitations: ___________________________________________________________Signed this day of ______, ______________________ , 20_____.Signature__________________________________________________________ Place___________________________________________________________If another person is to sign for the declarant at the declarant's direction, the person signing for the declarant must sign in the presence of two persons or a person who is qualified to take acknowledgments. The witness form below may be used for the two witnesses, one of whom must be disinterested in the estate of the donor.. The acknowledgement form below may be used for the person qualified to take acknowledgements. WITNESS FORM Witness Signature: ________________________________________________________Witness Name: ___________________________________________________________Address: ________________________________________________________________Witness Signature: ________________________________________________________Witness Name: ___________________________________________________________Address: ________________________________________________________________State of ___________________________Judicial District ____________________ ACKNOWLEDGEMENT FORM The foregoing instrument was acknowledged before me this __________________________ (date) by ____________________________________________ (name of person who acknowledged). Signature of Person Taking Acknowledgement:_______________________________________________Title or Rank: ___________________________________Serial Number, if any: _____________________________

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  4. Click Me (Fill Out Now) to prepare the form on your end.
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