Living Will Form Tennessee Page 4
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4Second witness’ signature: _________________________________________________
Printed name: ___________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Subscribed, sworn to and acknowledged before me by ____________________________________________________, the declarant,
and subscribed and sworn to before me by ________________________________________ and _____________________________
_____________, witnesses, this ______ day of_______________________, 20_______.
_____________________________________
(notary public)
AN ORGANIZATION OF
AMERICANS FOR LEGAL REFORM
Email:
Phone: 1-888-FOR-HALT
(202) 887-8255
Fax: (202) 887-9699
1612 K Street, NW Suite 510
Washington, DC 20006
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