State Of Ohio - Living Will Template (Page 2 of 3) in pdf

State Of Ohio - Living Will Template Page 2

First Contact:

Second Contact:

Name _________________________

Name:____________________________

Address: _______________________

Address: _________________________

_______________________________

_________________________________

Telephone: ______________________

Telephone: _______________________

This Living Will Declaration has no expiration date. However I may revoke it at any time.

Copies of the document are the same as the original. Any person may rely on a copy of this

document. I intend that this document be honored in any jurisdiction to the extent allowed by

law.

I have completed a Health Care Power of Attorney: _____Yes

_____No

I understand the purpose and effect of this document and sign my name to this Living

Will Declaration on _____________________________________, ____________,

(date)

(year)

At ______________________________________, Ohio.

(city)

Signature of Declarant: ______________________________________________

(You may either have this document witnessed by two people or by a Notary Public of the State

of Ohio. YOU DO NOT NEED BOTH. Either one is sufficient to validate the document.)

State Of Ohio - Living Will Template Page 2