#5500
@001 Please state the name of the declarant:
@002 Please enter the state where executed:
@003 Please enter the county where executed:
#end control section
#5500
/* Iowa living will*/


DECLARATION AS PROVIDED BY IOWA CODE 144A.3

	          DECLARATION OF @001



	If I should have an incurable or irreversible condition

that will cause my death within a relatively short time, it is

my desire that my life not be prolonged by administration of

life-sustaining procedures. If my condition is terminal and I

am unable to participate in decisions regarding my medical

treatment, I direct my attending physician to withhold or

withdraw procedures that merely prolong the dying process and

are not necessary to my comfort or freedom from pain.

Signed this _______________ day of _______________, 19_____

Signature:



________________________________________________________________

	The declarant is known to me and voluntarily signed this

document in my presence.

Witness:



________________________________________________________________

Address:



Witness:



________________________________________________________________

Address: