Montana Living Will Declaration Form
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Living Will Declaration
To My Family, My Physician, My Clergyman, My Lawyer, My Trust Officer
Declaration Made This_________________________ Day Of_________________________ 20______
I, _______________________________________________________________ being of sound
mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged
under the circumstances set forth below, and do hereby declare:
If, at any time, I should have an incurable injury, disease, or illness, certified to be a terminal
condition by my attending physician who has personally examined me and has determined that my
death will occur whether or not life-sustaining 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procedures be withheld or withdrawn and that I be permitted to die naturally with only the administration
of medication or the performance of any medical procedure deem