Step 1 of 2

  • NOTE: Please fill out the below fields that has an *

    Medical Care

    (Healthcare by State)

  • wish to make aware that after a mature adult consideration, and being aware of the knowledge and rights under the law to decline life sustaining treatment, that I wish, should I ever be unable to make a conscientious decision for myself, concerning my medical treatment, that I wish to receive life sustaining treatment even after a terminal diagnosis, even if life prolonging treatment will delay/detain the natural process of dying.

    I previously constructed a Living Will, pertaining to other documents expressing a desire, contrary to that specified, herein/expressly, and by this document, I hereby revoke the same.
  • witnesses who, being first and being duly sworn indicate that they are the subscribing/agree with witnesses to the declaration/statement of,

  • Declarant/Applicant, signed, sealed, and published, and declared the same as for his declaration/statement in the presence of both of these affiants; and these is affiants, at the request said Declarant/Applicant, in the presence of each other, and in the presence of the said Declarant/Applicant, all presence simultaneously, signed their names as attesting/certify witnesses to said declaration/statement.

    Affiants further say that this affidavit/affirmation is made at the request of,
  • at the time of the declaration/statement was executed, in the opinion of the affiant, of sound mind and memory and over the age of eighteen years.
  • MM slash DD slash YYYY
  • Revocation (Cancellation), of Previous Living Will

    and Medical Care

    (Healthcare by State)


    This review of said documentation covers in question your preparation of, Revocation of Previous Living Will and Medical Care Restriction. This application is generally changed because of serious thoughts of the affiant’s thoughts and point of view. As a result, you should be very careful in having your wishes implemented. These affidavits consist of,

    A. Three witnesses

    B. Have those three witness notaries

    C. Get the documents in everyone’s possession that previously have one

    D. Try to recover as many original as you can, that you handed out previously to avoid conflicting direction.