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LIVING WILL AND DIRECTIVE TO MY PHYSICIANS

Instructions

  1. After filling in the form, you will be prompted to confirm your order.
  2. Confirming the purchase will send you to PayPal to charge your credit card.
  3. After payment, PayPal will send you back to this website to see your finished document.
  4. All documents produced here are in PDF (Portable Document Format) and can be saved on your computer or viewed with an application like Adobe Acrobat Reader and printed.
  5. The documents produced here can optionally be sent by email as well.
  6. Fill in the entries as described.

Your name
Your address
Your city
Your state
Your ZIP code

(1) NAME OF PERSON
(2) ADDRESS OF PERSON
(3) CITY OF PERSON
(4) COUNTY OF PERSON
(5) STATE OF PERSON
(6) ZIP CODE OF PERSON
(7) PHONE OF PERSON
(8) **USE HEROIC MEASURES (Y/N)
(9) STOP HEROIC MEASURES AND LET ME DIE (Y/N)
(10) **USE THIS DOCUMENT (Y/N)
(11) I AM MENTALLY COMPETENT TO WRITE THIS DOCUMENT (Y/N)
(12) I HAVE A RIGHT TO REVOKE THIS DOCUMENT ANYTIME (Y/N)
(13) DATE OF AUTOMATIC REVOCATION OF THIS DOCUMENT
(14) DATE
(15) WITNESS (1)
(16) ADDRESS OF WITNESS (1)
(17) WITNESS (2)
(18) ADDRESS OF WITNESS (2)
(19) WITNESS (3)
(20) ADDRESS OF WITNESS (3)
(21) STATE OF NOTARIZATION
(22) COUNTY OF NOTARIZATION
(23) NAME OF TRUSTES
(24) ADDRESS OF TRUSTEE

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