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Create Your Living Will and Directive to Your Physicians (981)

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Some jurisdictions require that a Living Will be notarized by a Notary Public in order to be valid.

Some jurisdictions require that a Living Will be notarized by a licenced law practitioner (lawyer).

Check with your local authorities.


The patient has already been diagnosed with an incurable illness.

(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  Yes  No
(9) Stop Heroic Measures And Let Me Die  Yes  No
(10) **Use This Document  Yes  No
(11) I Am Mentally Competent To Write This Document  Yes  No
(12) I Have A Right To Revoke This Document Anytime  Yes  No
(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 Terminal Condition
(24) Name of MD (1)
(25) Address of MD(1)
(26) City of MD (1)
(27) State of MD (1)
(28) Phone of MD (1)
(29) Name of MD (2)
(30) Address of MD (2)
(31) City of MD (2)
(32) State of MD (2)
(33) Phone of MD (2)
(34) Enter User Name
(35) Password for Edit
(36) Password for Read

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