DIRECTIONS OF ________________ 

 I, _______________, of _______________, ________, __________,
herewith state: 

1. I am of sound mind and have reached the age of majority. 

2. After due and mature deliberation I have decided that it is
consistent with my religious, moral and ethical beliefs that if I
should ever be certfied under the New Mexico Right to Die Act as
suffering from a terminal condition that "maintainence medical
treatment" as is defined by that act shall not be utilized to
prolong my life. 

3. If the time comes when I, ________________, can no longer take
part in  decisions of my own future, let this statement stand as
an  expression of my wishes while I am still of sound mind. 

4. This statement is made after careful consideration and is in
accordance with my strong convictions and beliefs. I want the
wishes and directions here expressed carried out to the  extent
permitted by law. Insofar as they are not legally  enforceable, I
hope that those to whom this will is addressed  will regard
themselves as morally bound by these provisions. 


 Signed: 





 _______________________________________________________________ 


 Date: _________________ 

 Witnesses: 



 ________________________________________________________________ 





 ________________________________________________________________