Fillable Living Will Template (Fillable) printable pdf download

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LIVING WILL

To Use This Form:

You can fill out your name and other information on this form with your computer using Adobe's PDF program. Click on the blank fields to input your name, and use the

checkboxes to indicate your other preferences. Have two witnesses sign and date the bottom of your living will.

(Name of Declarant), being of sound mind and at least eighteen years of age, direct that my life shall not be

artificially prolonged under the circumstances set forth below and hereby declare that:

1. If at any time my attending physician and one other physician certify in writing that:

1. I have an injury, disease or illness which is not curable or reversible and which, in their judgment, is a terminal condition; and

2. For a period of 7 days or more, I have been unconscious, comatose or otherwise incompetent so as to be unable to make or communicate

responsible decisions concerning my person.

Then I direct that, in accordance with Colorado law, life-sustaining procedures shall be withdrawn and withheld pursuant to the terms of this

declaration; it be understood that life-sustaining procedures shall not include any medical procedure or intervention for nourishment considered

necessary by the attending physician to provide comfort or alleviate pain. However, I may specifically direct, in accordance with Colorado law, that

artificial nourishment be withdrawn or withheld pursuant to the terms of this declaration.

2. In the event that the only procedure I am being provided is artificial nourishment, I direct that one of the following actions be taken:

A. artificial nourishment shall not be continued when it is the only procedure being provided; or

B. artificial nourishment shall be continued for

days when it is the only procedure being provided; or

C. artificial nourishment shall be continued when it is the only procedure being provided.

3. I execute this declaration as my free and voluntary act this

day of

BY:

(Signature of Declarant)

The foregoing instrument was signed and declared by:

(Name of Declarant)

To be his/her declaration, in the presence of us, who is his/her presence, in the presence of each other, an at his/her request have signed our names

below as witnesses, and we declare that, at the time of the execution of this instrument, the declarant, according to our best knowledge and belief,

was of sound mind and under no constraint or undue influence.

Dated at ___________________________________________, Colorado,

this _______________ day of _________________________, 20________.

Signature of Witness 1: _____________________________________________

Address of Witness 1: ______________________________________________

Signature of Witness 2: _____________________________________________

Address of Witness 2: ______________________________________________

STATE OF COLORADO

)

) ss

COUNTY OF _____________ )

Subscribed and sworn to me this ____________ day of __________________,

20________, by __________________________________.

Witness my hand and official seal.

My commission expires: __________________________________

Notary Public ________________________________

Living Will Template (Fillable)

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