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Complete Home & Office Legal Guide
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Complete Home and Office Legal Guide (Chestnut) (1993).ISO
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1993-08-01
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DECLARATION AS PROVIDED BY MONTANA STATS. 50-9-104
DECLARATION
If I should have an incurable or irreversible condition that will
cause my death within a reasonable short time, it is my desire
that my life not be prolonged by administration of life-sustaining
procedures. If my condition is terminal and I am unable to
participate in decisions regarding my medical treatment, I direct
my attending physician to withhold or withdraw procedures that
merely prolong the dying process and are not necessary to my
comfort or freedom from pain. It is my intention that this
declaration shall be valid until revoked by me.
Signed this ___________________ day of ______________
________________________________________________________________
Signature - ______________
City of residence: __________________
County of residence: ________________
State of residence: _________________
The declarant is known to me and voluntarily signed this
document in my presence.
Witness:
_____________________________________________________________
Witness:
_____________________________________________________________