"I, ________________, do hereby designate ___________________ with the right to control the disposition of my remains upon my death. I ___ have/ ____ have not attached specific directions concerning the disposition of my remains with which the designee shall substantially comply, provided that these directions are lawful and there are sufficient resources in my estate to carry out the directions.
______________________________
Signed
State of _______________
County of ______________
I, _________________________, a Notary Public of said County, do certify that _____________________________________, as principal whose name is signed to the writing above bearing date on the ______ day of _________, 20____, has this day acknowledged the same before me.
Given under my hand this ______ day of ______, 20__.
My commission expires: _______________________________
____________________________
Notary Public";
W. Va. Code § 30-6-22a