#5570
@001 Please state the name of the declarant: 
#end control section
#5570
/* Maine living will */
DECLARATION PROVIDED BY MAINE REVISED STATUTES
TITLE 22 SECTION 2922



                           DECLARATION



	If I should have an incurable or irreversible condition

that will cause my death within a short time, and if 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 _______________________________

             date                month                  year




Signature ______________________________________________

          @001
          
              
The declarant is known to me and voluntarily signed this document

in my presence.



        Witness ________________________________________________


        Address:


        Witness ________________________________________________

        Address: