Free Anatomical Gift Revocation Agreement

This Revocation of Anatomical Gift revokes a previously made Organ Donation Agreement. This revocation sets forth the date of the original agreement, the name of the donor and identity of the done. This Revocation of Anatomical Gift must be signed by the original donor.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.




Revocation of Anatomical Gift

On this _______ day of _____________________________, 20___________ I, __________________ of __________________________________________ (the “Donor”) hereby fully and completely revoke the Anatomical Gift dated _________________ made in favor of ______________________ (the “Donee”).

______________________________
Signature of Donor

______________________________
Printed Name of Donor

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