North Dakota Living Will Page 2
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2f. I understand the importance of this declaration, I am voluntarily signing this declaration, I am at least eighteen years of age, and
I am emotionally and mentally competent to make this declaration.
g. I understand that I may revoke this declaration at any time.
______________________________________________________
Signed
______________________________________________________
City, County, and State of Residence
h. Notary Public
In my presence on_______________________ (date), ____________________________ (name of declarant) acknowledged
the declarant’s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the
declarant’s behalf.
______________________________________________
(Signature of Notary Public)
My commission expires__________________ , 20_____.
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