#5700
@001 Please state the name of the declarant:
@002 Please state the city of the declarant's residence:
@003 Please state the state of the declarant's residence: 
#end control section
#5700
/* Paragraph 4100: Tennessee Living Will */
LIVING WILL AS PROVIDED BY TENNESSEE CODE 32-11-105

	LIVING WILL OF @001



I, @001, willfully and voluntarily make known my desires that my 
dying shall not be artificially prolonged under the circumstances 
set forth below, and do hereby declare:


	If at any time I should have a terminal condition and
my attending physician has determined that there can be no
recovery from such condition and my death is imminent, and where
the application of life-prolonging procedures would serve only
to artificially prolong the dying process, I direct that such
procedures be withheld or withdrawn, and that I be permitted to
die naturally with only the administration of medications or the
performance of any medical procedure deemed necessary to
provide me with comfort care or to alleviate pain.


	In the absence of my ability to give directions
regarding the use of such life-sustaining procedures, it is
my intention that this declaration shall be honored by my
family and physicians as the final expression of my legal right
to refuse medical or surgical treatment and accept the
consequences from such refusal.


	I understand the full import of this declaration and
I am emotionally and mentally competent to make this
declaration. In acknowledgement whereof, I do hereinafter


affix my signature on this the ___________ day of ______________


19___________.




_____________________________________________________________
Declarant- @001

Residing at : @002

@003

We, the subscribing witnesses hereto, are personally acquainted
with and subscribe our names hereto at the request of the
declarant, an adult, whom we believe to be of sound mind, fully
aware of the action taken herein and its possible consequence.
We, the undersigned witnesses, further declare that we are not
related to the declarant by blood or marriage; that we are not
entitled to any portion of the estate of the declarant upon his
decease under any will or codicil thereto presently existing or
by operation of law then existing; that we are not the attending
physician, an employee of the attending physician or a health
facility in which the declarant is a patient; and that we are
not a person who, at the present time, has a claim against any
portion of the estate of the declarant upon his death.





Witness 	______________________________________________





Witness        _______________________________________________



Subscribed, sworn to and acknowledged before me by
@001, the declarant, and subscribed to before me


by __________________________ and _____________________________,


witnesses, this _______ day of ___________________________ 19___.





_______________________________________________________________

Notary Public