#5005
@001 State the name of the declarant: 
#end control section
#5005
/* Connecticut Living Will*/


LIVING TESTAMENT AS PROVIDED BY CONNECTICUT STATUTES
SECTION 19a-575


                            TESTAMENT


	If the time comes when I am incapacitated to the

point where I can no longer actively take part in decisions

for my own life, and am unable to direct my physician as to

my own medical care, I wish this statement to stand as a

testament of my wishes. I @001 request that I be allowed to die

and not be kept alive through life support system if my condition

is deemed terminal. I do not intend any direct taking of my life,

but only that my dying not be unreasonably prolonged. 


This request is made, after careful reflection, while I am of 

sound mind.









        Signed ______________________________________________
               @001


Witness       __________________________________________________



Witness       __________________________________________________