End-of-Life Plan for laurie lee coots

I, laurie lee coots, currently of springfield, MO, being of sound mind, willfully and voluntarily declare
that these are my final wishes as to the disposition of my body after my death and any services or
memorialization to be held in my name.

This document is not intended to be interpreted as my Last Will and Testament.

Appointees

a. I request that the following individuals be in charge of planning and executing my last
wishes:

charmin chereese carroll, currently of brrookline, MO.

dixie lea devoe, currently of hemet, CA

Death Announcement

a. I wish to have an obituary submitted to springfield newsleader in springfield mo,

b. My obituary should include my:

Date of birth: August 4, 1972
Birthplace: atlanta, georgia

c. I would also like the details of my funeral or other service to be included in my obituary,
so that anyone has the option to attend.

Organ Donation

a. I wish to donate my organs upon my death and am a registered organ donor in the state of
Missouri.

Page 1 of 3
End-of-Life Plan Page 2 of 3

Final Disposition of My Body

a. Upon my death, I wish my body to be cremated.

b. I wish my ashes to be divided among:

my daughter, marcella laree donson

my cousin, charmin chereese carroll

my cousin, dixie lea devoe

Services in My Memory

a. Upon my death, I wish to have the following services to commemorate my life:

i. Visitation

ii. Memorial Service

Financing

a. I have set aside funds to cover my expenses: gerber life insurance grandma had on me.

Final Thoughts

a. I wish the following thoughts to be shared after my death: i will write the message later.

I recognize that it may not be possible for my appointees to fulfill all of my wishes and request that
charmin chereese carroll, and dixie lea devoe act to follow the spirit of these wishes as well as they can
and within the limits of any applicable law.
End-of-Life Plan Page 3 of 3

SIGNATURE

_________________________ _________________________
Date
laurie lee coots

WITNESSES

SIGNED AND DECLARED by laurie lee coots on the ______ day of ________________, ________
to be the declarant’s End-of-Life Plan expressing their own wishes as to the disposition of their body
and any services to be held in their name. We declare that laurie lee coots is personally known to us,
that they signed this End-of-Life Plan in our presence, and that they appeared to be of sound mind and
not acting under duress, fraud, or undue influence.

_________________________ _________________________
Witness #1 Signature Witness #2 Signature
_________________________ _________________________
Witness #1 Name (please print) Witness #2 Name (please print)
_________________________ _________________________
Date Date

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