OHIO CERTIFICATE OF RELIGIOUS BELIEF Pursuant to Ohio Code 313.131, I hereby execute this Certificate of Religious Belief: Ay autopsy of my body is a 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: ________________________
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