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Important
Note:
Forms are to be used as a guide only to assist you. No liability is assumed for errors in substance or form. It is your responsibility to revise the forms to meet current law
requirements and your particular situation. No liability is assumed for improper use of these forms.
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Declaration
of Witnesses
The declarant is
personally known to me and I believe her to be of sound mind and
emotionally and
legally competent to make the herein contained Directive to Physicians. I am not
related to the
declarant by blood or marriage, nor would I be entitled to any portion of the
declarant's
estate upon her
decease, nor am I an attending physician of the declarant, nor an employee of
the
attending
physician, nor an employee of a health care facility in which the declarant is a
patient, nor
a patient in a
health care facility in which the declarant is a patient, nor am I a person who
has any
claim against
any portion of the estate of the declarant upon her death.
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