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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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48 lines
UNIFORM LIVING WILL
OF _____________________
To my family, my physician, my lawyer, my clergyman. To any
medical facility in whose care I happen to be. To any individual
who may become responsible for my health, welfare or affairs.
Death is as much a reality as birth, growth, maturity and old age
-- it is the one certainty of life. 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.
If the situation should arise in which I am in terminal state and
there is no reasonable expectation of my recovery, I direct that I
be allowed to die a natural death and that my life not be
prolonged by extraordinary measures. I do, however, ask that
medication be mercifully administered to me to alleviate suffering
even though this may shorten my remaining life.
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:
_______________________________________________________________
City of residence: _________________
County of residence: _______________
State of residence: ________________
Social Security Number: ____________
Date: _________________
________________________________________________________________
Witness:
________________________________________________________________
Witness: