#5630
@001 State the name of the declarant:
@002 State the street address of declarant:
@003 State the city, state address of declarant: 
#end control section
#5630
/* Para. 4030: New Mexico Living Will */

DIRECTIONS UNDER THE NEW MEXICO RIGHT TO DIE ACT

                 DIRECTIONS OF @001

 I, @001, of @002, @003, herewith state:


1. I am of sound mind and have reached the age of majority.


2. After due and mature deliberation I have decided that it is
consistent with my religious, moral and ethical beliefs that if
I should ever be certfied under the New Mexico Right to Die Act
as suffering from a terminal condition that "maintainence medical
treatment" as is defined by that act shall not be utilized to
prolong my life.


3. If the time comes when I, @001, can no longer take part in 
decisions of my own future, let this statement stand as an 
expression of my wishes while I am still of sound mind.


4. This statement is made after careful consideration and
is in accordance with my strong convictions and beliefs. I want
the wishes and directions here expressed carried out to the 
extent permitted by law. Insofar as they are not legally 
enforceable, I hope that those to whom this will is addressed 
will regard themselves as morally bound by these provisions.


 Signed:





 _______________________________________________________________
 @001

 Date: _________________

 Witnesses:



 ________________________________________________________________





 ________________________________________________________________