Living Will (Male)

9/5/2013

I, __________(1)_____________, of ___________(2)____________,
being of sound mind, do hereby willfully and voluntarily make
known my desire that my life not be prolonged under any of the
following conditions, and do hereby further declare:

1. If I should, at any time, have an incurable condition
caused by any disease or illness, or by any accident or
injury, and be determined by any two or more physicians to be
in a terminal condition whereby the use of "heroic measures"
or the application of life-sustaining procedures would only
serve to delay the moment of my death, and where my attending
physician has determined that my death is imminent whether or
not such "heroic measures" or life-sustaining measures are
employed, I direct that such measures and procedures be
withheld or withdrawn and that I be permitted to die
naturally.

2. In the event of my inability to give directions regarding
the application of life-sustaining procedures or the use of
"heroic measures", it is my intention that this directive
shall be honored by my family and physicians as my final
expression of my right to refuse medical and surgical
treatment, and my acceptance of the consequences of such
refusal.

3. I am mentally, emotionally and legally competent to make
this directive and I fully understand its import.

4. I reserve the right to revoke this directive at any time.

5. This directive shall remain in force until revoked.

IN WITNESS WHEREOF, I have hereto set my hand and seal this
_(3)_ day of _______(4)_______, 20_(5)_.

                             ______________(6)______________

Declaration of Witnesses

The declarant is personally known to me and I believe him to
be of sound mind and emotionally and legally competent to make
the herein contined Directive to Physicians. I am not related
to the declarant by blood or marriage, nor would I be entitled
to any portion of the declarant's estate upon his decease, nor
am I an attending physician of the declarant, nor an employee
of the attending physician, nor an employee of a health care
facility in which the declarant is a patient, nor a patient in
a health care facility in which the declarant is a patient,
nor am I a person who has any claim against any portion of the
estate of the declarant upon his death.

__________(7)_______________    ___________(8)_____________

__________(9)_______________    ___________(10)____________

_________(11)_______________    ___________(12)____________

Notice

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.

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