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‘THE ANATOMY ACT — PROVINCE OF ONTARIO. PARTI- DONATION OF BODY TO SCHOOL OF ANATOMY L. Gra fi Sem" having attained the age of 16 years, hereby consent in accordance with Section 4 of ‘The Trillium Gift of Life Network Act, to the use of my body after death for medical education or for sciemtfic research at the School of Anatomy at or at any other School of Anatomy Dated at ; ee ceday Of eee eee ee es 20 (Signature Of Donor) ‘Aadress) PARTIt- DONATION OF BODY TO A SCHOOL OF ANATOMY. BY NEXT-OFKIN OR A PERSON LAWFULLY IN POSSESSION L . ev Fil Ney being the next-of kin or a person lawfully in possession of the body of (Print Futl Name) hereby consent in accordance with Section 5 of'The Trillium Gift of Life Network Act, to the use of the said body after death for medical education or for scientific research, at the School of Anatomy at, or at any other School of Anatomy. Dated at oe day of .. 20 (Gigeature OF Doaoe) ‘Relationship To Deceased) (aires) {lelephone Number) Nor PART SHOULD BE COMPLETED BY THE PERSON WISHING TO DONATE HIS BODY WHEN THAT DECISION IS MADE, PART n- SHOULD BE COMPLETED BY THE NEXTORKIN OR PERSON LAWFULLY IN POSSESSION OFTHE BODY ONLY WHERE THE DECEASED HAS NOT PERSONALLY DONATED HIS BODY BY COMPLETING ‘THE FIRST PART OF THE FORM. (COMPLETE EITHER PART I OR PART Il OF THIS FORM, BUT NOT BOTH. (CC 111-1 ew. 09/00) Original to be returned to School of Anatomy.