Pursuant to New York Public Health Law Section 4210-c(1),
I hereby execute this Certificate of Religious Belief: Any 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: __________________________________ SOURCE: New York Certificate of Religious Belief