New York Appointment of Agent to Control Disposition of Remains
Appointment of Agent to Control Disposition of Remains
I, [YOUR FULL NAME AND ADDRESS], being of sound mind, willfully and voluntarily make known my desire that, upon my death, the disposition of my remains shall be controlled by [NAME OF AGENT]. With respect to that subject only, I hereby appoint such person as my agent with respect to the disposition of my remains.
Special directions
Set forth below are any special directions limiting the power granted to my agent as well as any instructions or wishes desired to be followed in the disposition of my remains:
[SPECIAL DIRECTIONS / NONE]
Indicate below if you have entered into a pre-funded pre-need agreement subject to section four hundred fifty-three of the general business law for funeral merchandise or service in advance of need:
☐ No, I have not entered into a pre-funded pre-need agreement subject to section four hundred fifty-three of the general business law.
☐ Yes, I have entered into a pre-funded pre-need agreement subject to section four hundred fifty-three of the general business law.
Funeral firm with which I entered into the agreement to provide merchandise or services: [NAME / NONE]
Agent
Name: [FULL NAME]
Address: [FULL ADDRESS]
Telephone Number: [NUMBER]
Successors
If my agent dies, resigns, or is unable to act, I hereby appoint the following persons (each to act alone and successively, in the order named) to serve as my agent to control the disposition of my remains as authorized by this document:
1. First Successor
Name: [FULL NAME]
Address: [FULL ADDRESS]
Telephone Number: [NUMBER]
2. Second Successor
Name: [FULL NAME]
Address: [FULL ADDRESS]
Telephone Number: [NUMBER]
Duration
This appointment becomes effective upon my death.
Prior appointment revoked
I hereby revoke any prior appointment of any person to control the disposition of my remains.
Signed this [DAY] day of [MONTH], [YEAR].
Signature of person making the appointment: ______________________________
Statement by witnesses (each must be 18 or older)
I declare that the person who executed this document is personally known to me and appears to be of sound mind and acting of his or her free will. He or she signed (or asked another to sign for him or her) this document in my presence.
Witness 1 signature: ______________________________
Address: [FULL ADDRESS]
Witness 2 signature: ______________________________
Address: [FULL ADDRESS]
Acceptance and assumption by agent
-
I have no reason to believe there has been a revocation of this appointment to control disposition of remains.
-
I hereby accept this appointment.
Signed this [DAY] day of [MONTH], [YEAR].
Signature of agent: ______________________________
Source
About this template
- Last updated
- October 24, 2026
- Citations checked
- October 24, 2026
- Jurisdiction
- New York
- Category
- Estate Planning & Wills
Legal authority
- N.Y. Pub. Health Law § 4201(2)(a)(i), (3), (5)
Estate planning documents decide what happens to your property, your children, and your medical care when you cannot make those decisions yourself. Wills, trusts, powers of attorney, and health care directives each serve different purposes and each have to meet state law requirements for signing, witnessing, and notarization. A document that looks fine on the page but was not executed correctly can be rejected in probate, which is exactly when it is too late to fix.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 24, 2026.
N.Y. Pub. Health Law § 4201(2)(a)(i) (checked October 24, 2026): "the person designated in a written instrument executed pursuant to the provisions of this section"
N.Y. Pub. Health Law § 4201(3) (checked October 24, 2026): "The written instrument referred to in paragraph (a) of subdivision two of this section may be in substantially the following form, and must be signed and dated by the decedent and the agent and properly witnessed"
N.Y. Pub. Health Law § 4201(5) (checked October 24, 2026): "The designation of the decedent's spouse or domestic partner as an agent in control of disposition of remains shall be revoked upon the divorce or legal separation of the decedent and spouse, or termination of the domestic partnership, unless the decedent specified in writing otherwise."
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