#5892
@001 Please state the name of the person executing this document:
#5893 Has this person previously executed a living will?
#5894 
#end control section
#5892
/* Paragraph 5892: Living Won't */

         DECLARATION OF DESIRES AS TO MEDICAL CARE


I, @001, desire to make aware that after mature reflection, and,
being aware of the right under the law to decline life-
sustaining treatment, that I wish, should I ever be unable to
make decisions for myself concerning my medical treatment that 
I receive life sustaining treatment even after a terminal 
diagnosis, even if the life prolonging treatment will delay
the natural process of dying. 
#5893
/* Para. 4731: Revocation of living will */


I have previously made a "living will" or other document 
expressing a desire contrary to that specified herein, and by
this document I herewith revoke the same.
#5894
/* 5894: end of the living wont */


Dated: _________________________________________






________________________________________________
Declarant