LAST WILL AND TESTAMENT

REGARDING THE DISPOSITION OF MY HUMAN REMAINS

FIRST: I, ________________________________________ declare this to be my Will (Codicil  to my Will dated ___________________________ ) directing the disposition of my human remains.

SECOND: I hereby revoke all contrary provisions in any prior Will or Codicil, and republish all other provisions by this instrument.

THIRD: I am over eighteen (18) years of age and currently reside at:

____________________________________________________________

____________________________________________________________

FOURTH: I direct that my human remains be preserved by the cryogenic treatment known as Cryonic Suspension.

FIFTH: I direct that my human remains not be embalmed, expressly forbid voluntary autopsy, and ask that my Executor and next of kin immediately carry out the directions of this instrument.

SIXTH: I authorize anyone having possession of my medical records to furnish them to the Cryonics Institute and direct my Executor and next of kin to provide whatever assistance is requested by the Cryonics Institute to obtain such records.

SEVENTH: If I have executed a "Cryonic Suspension Agreement" with the Cryonics Institute, I direct that this document be incorporated as a part of this, my Last Will and Testament.

EIGHTH: I realize and accept the fact that cryogenic treatment of human remains is new, experimental, unperfected, and involves unforeseeable medical and technical problems. I further realize that the treatment is not consistent with contemporary medical or mortuary practice, and that any expectation of being restored to life and health at some future date is speculative. I therefore hold my Executor, next of kin, Health Care Agent, or anyone else acting pursuant to the provisions of this instrument free of any liability arising from acts or omissions done in good faith. I intend this release to be binding on my heirs and beneficiaries.

NINTH: If any beneficiary contests, attacks or acts contrary to the directions of this instrument, any share or interest in my testamentary estate or trust estate given to that beneficiary under my Will is revoked. If any heir contests, attacks or acts contrary to the directions of this instrument, I give that heir the sum of one dollar ($1.00) and revoke any other testamentary disposition that may have been made to such heir and his or her issue.

TENTH: Should this instrument not be a codicil, and must serve as my final Will, I nominate the following person(s) to act as Executor, in the priority listed, to serve without bond:

_________________________________________________________________

_________________________________________________________________

___________________________________________________ _____________

Signature of Testator                                                                             Date

ATTESTATION CLAUSE

On the date written below the testator of this instrument,

_____________________________________________ (name), declared to us the undersigned, that this instrument consisting of two pages including this page signed by us as witnesses and any added pages incorporated in this instrument, was the testator's (Will) (Codicil), that s/he knows the contents thereof, and requested us to act as witnesses to it. The testator thereupon initialed pen alterations and deletions in this instrument, signed the bottom of each page herein, and signed this instrument; all being done in our presence with each of us being present at the same time. We now, at testator's request, in testator's presence and in the presence of each other, subscribe our names as witnesses.

DECLARATION OF WITNESSES

We declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on the date of _____________________ , at the city, state and country of

______________________________________________________________________

under the laws of the State of ____________________.

___________________________________ _________________________________

Signature of Witness 1                                                    Print name

____________________________________________________________________

address

_____________________________________________ _____________________

city, state, zip code                                                                   Social Security No.

___________________________________ ___________________________________

Signature of Witness 2                                                                 Print name

________________________________________________________________________

address

____________________________________________________ __________________

city, state, zip code                                                                                 Social Security No.