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District of Columbia Address: ______________________________________ Date:__________________ Date:__________________ 2 e: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________hysician, an employee of the attending physician, or an employee of the health facility in which the declarant is a patient. _____________________________________________ (Witness Signature) Print Namor directly financially responsible for declarant's medical care. I am not the health-care provider of the declarant or an employee of the health-care provider of the principal declarant's attending pod or marriage, entitled to any portion of the estate of the declarant according to the laws of intestate succession of the District of Columbia or under any will of the declarant or codicil thereto, , fraud, or undue influence. I did not sign the declarant's 1 signature above for or at the direction of the declarant. I am at least eighteen years of age and am not related to the declarant by blo__ _____________________________________________________________________ I declare that the declarant is personally known to me and that I believe the declarant to be of sound mind and under no duresstionally and mentally competent to make this declaration. Declarant's Signature: __________________________________________________ Address ____________________________________________________________ treatment and accept the consequences from such refusal. By my signature I indicate that I understand the purpose and effect of this document and the full import of this declaration and that I am emo use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical_____________________________________________________________ ____________________________________________________________________________ In the absence of my ability to give directions regarding the Other directions: (optional): ____________________________________________________________________________ ____________________________________________________________________________ _______________, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain.ining procedures are utilized and where the application of life-sustaining procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawnterminal condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustay desires that my dying shall not be artificially prolonged under the circumstances set forth below, do declare: If at any time I should have an incurable injury, disease or illness certified to be a day of _______________________________.(date) (month, year) I, _____________________________________________________________________, (name) being of sound mind, willfully and voluntarily make known md with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION Declaration made this __________ s your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussevice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fitbeen made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax adtrict of Columbia Living Will is based on Title 21 Chapter 22 Section 21-2201 et. Seq. of the District of Columbia Code. [_] These forms are provided "as is" and no implied or express warranties have Information and Instructions District of Columbia Living Will This package contains (1) Information and Instruction for District of Columbia Living Will; (2) District of Columbia Living Will. This Dis District of Columbia