Living Will Template Page 2
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27. I understand the full import of this declaration and I am emotionally and mentally
competent to make this declaration. I hope you, who care for me, will feel morally bound
to follow its mandate. I recognize that this appears to place a heavy responsibility upon
you, but it is with the intention of relieving you of such responsibility and of placing it
upon myself, in accordance with my strong convictions, that this statement is made.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my seal
at _______________, _______________, this _____ day of ____________, 20____, in
the presence of the subscribing witnesses whom I have requested to become attesting
witnesses hereto.
_____________________________
Declarant Signature
The declarant is known to me and I believe him/her to be of sound mind.
____________________________
_____________________________
Witness Signature
Address
____________________________
_____________________________
Witness Signature
Address
State of _____________ )
) ss.
County of ____________ )
The foregoing instrument was acknowledged by me this ______ day of
_________________, 20 ____ by _______________________________ who is/are
personally known by me or who has/have produced ______________________ as
identification and who did not take an oath.
________________________________ (SEAL)
Notary Public
State of _______________
My Commission Expires: _______________
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