#5600
@001 Please state the name of the declarant:
@002 Please state the city where signed:
@003 Please state the county where signed:
@004 Please state the state where signed: 
#end control section
#5600
/* Para. 5600 Montana*/
DECLARATION AS PROVIDED BY MONTANA STATS. 50-9-104


			DECLARATION



	If I should have an incurable or irreversible
condition that will cause my death within a reasonable
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. It is my intention that this
declaration shall be valid until revoked by me.


Signed this ___________________ day of ______________





________________________________________________________________

Signature - @001


City of residence: @002

County of residence: @003

State of residence: @004



	The declarant is known to me and voluntarily signed this

document in my presence.



Witness:



_____________________________________________________________




Witness:





_____________________________________________________________