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NEW JERSEY CERTIFICATE OF RELIGIOUS BELIEF

Pursuant to New Jersey Statutes Annotated Section 52:17B-88.2,
I hereby execute this Certificate of Religious Belief:

Any autopsy of my body is violation of my religious beliefs.
Any procedure which allows the post-mortem deterioration
of my body is a violation of my religious beliefs. Further,
it is my wish and directive that my remains be placed into
cryopreservation as soon as possible following my death.

Dated: ___________________________________

Signed: __________________________________

Printed Name: _____________________________

Witnessed:

Dated: ____________________________________

Signed: ____________________________________

Printed Name: ______________________________

Address: __________________________________

Witnessed:

Dated: ____________________________________

Signed: ____________________________________

Printed Name: ______________________________

Address: __________________________________