CERTIFICATE OF RELIGIOUS BELIEF

(GOVERNMENT CODE SS27491.43)

I, LAFAYETTE RONALD HUBBARD, declare:

1) I am a resident of the state of California and over
eighteen (18) years of age.

2) Based upon my religious beliefs, I object to any and
all post mortem anatomical dissections or other autopsy
procedures being conducted on my body. Such autopsy
procedures would violate my religious convictions.

IN WITNESS WHEREOF, I have executed this Certificate of
[Relig]ious Belief this 20 day of Jan, 1986.

[signed and overlaid with fingerprints]

WITNESSES

We declare under penalty of Perjury that the foregoing is
[true] and correct.

[N]ame: PATRICK D. BROEKER
(print)

[Re]sidential address: STAR ROUTE CRESTON
CRESTON, CA 93432

[S]ignature: [signed Patrick D. Broeker]

[Cert]ificate of Religious Belief p.2

[N]ame: ANNE M. BROEKER
(print)
[R]esidential address: STAR ROUTE CRESTON
CRESTON, CA 93432

[S]ignature: [signed Anne M. Broeker]

[N]ame: Stephen J. PFAUTH
(print)

[R]esidential address: Star Route Creston
Creston, CA
93432

[S]ignature: [signed Stephen J. Pfauth]

[signed and overlaid with fingerprint L. Ron Hubbard]

OCRed from images webbed at http://www.xenu.net/archive/hubbardcoroner/