Home Join Now Learn More Sign in
Home | Admin | Sign Out 
Find a Form 

Access thousands of free legal and business forms contributed by leading lawyers and other professionals

Search by key words (e.g., "Sales Contract")
Advanced search

 
Promote Your Business  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Promote Your Business 
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Promote your business  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Add your free profile  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
 
Connect

Terms Of Use

Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
Close

Thank you for using
Yourfreelegalforms.com


Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile displayed on the same page as the form for free, powerfull, targeted marketing to those searching for legal forms and advice.

Advertise your business to thousands for free – Contribute a form
Form #1129

Living Will Declaration - Indiana

Average user rating:  
Not Yet Rated
Rate it

Living Will, Indiana

Need this form customized? Download This Form Printer Friendly Version

LIVING WILL DECLARATION

            DECLARATION made this _________ day of ____________________________, 20______.

 

            I, ____________________, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known by desires that my dying shall not be artificially prolonged under the circumstances set forth below, and I declare:

 

            If at any time my attending physician certifies in writing that:

1.   I have an incurable injury, disease or illness;

2.   My death will occur within a short time; and

3.   The use 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 performance or provision of any medical procedure or medication necessary to provide me with comfort care or to alleviate pain and, if I have so indicated below, the provision of artificially supplied nutrition and hydration (Indicate your choice by initialing or making your mark before signing this declaration):

 

            ___________  I wish to receive artificially supplied nutrition and hydration, even if the effort to sustain life is futile or excessively burdensome to me.

            ___________  I do not wish to receive artificially supplied nutrition and hydration, if the effort to sustain life is futile or excessively burdensome to me.

            ___________  I intentionally make no decision concerning artificially supplied nutrition and hydration, leaving the decision to my health care representative appointed under I.C. 16-36-1-7 or my attorney in fact with health care powers under I.C. 30-5-5-16 and I.C. 30-5-5-17. 

 

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

           

            I understand the full import of this declaration.

 

                                                                                    ___________________________________

                                                                                   

 

                                                                                    ___________________________________

                                                                                    City, County and State of Residence

 

 

 

            _____________________ has been personally known to me, and I believe him/her to be of sound mind.

 

            I did not sign his/her signature above for or at the direction of _________________.

           

            I am not entitled to any part of ____________________ estate or directly financially responsible for his/her medical care.

 

            I am competent and at least eighteen (18) years of age.

 

 

DATED: ____________________________           ___________________________________

                                                                                    WITNESS

 

DATED: ____________________________           ___________________________________

                                                                                    WITNESS

 

 

Attorney Advertising
Dugan & Repay LLP is only advertising in states where they are admitted to practice
Contributed by
Dugan & Repay LLP
 
Name of Firm Dugan & Repay LLP
Profession (lawyer symbol)   Lawyer
Number of lawyers in firm 2
Branch of Law Personal Injury, Workers Compensation, Estate Planning, Family, Employment & Labor,
Location Schererville, Indiana, United States
Principal Office Address Dugan & Repay LLP 7656 Harvest Drive Schererville, IN 46375
Practicing law since 1/1/1997
Total Forms Contributed 3
Phone 2198649922
Website http://www.dr-legal.com
Email
 Full service law firm
State Advertising Disclaimer:
Dugan & Repay, LLP is only advertising in states where they are admitted to practice.
Dugan & Repay, LLP is only advertising in states where they are admitted to practice.

See All Dugan & Repay LLP's Forms
 

Related Forms

Revocable Living Trust
Approval from Spouse for Living Trust
Living Will for Arizona
California Declaration
Declaration - Design Patent Application

Terms Of Use

Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
Close

Thank you for using
Yourfreelegalforms.com


Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile displayed on the same page as the form for free, powerfull, targeted marketing to those searching for legal forms and advice.



Was this form helpful? Yes No
Need a different form? Yes No


Need a different form? Need a custom form or service?

Contact this contributor  or post a request to our community.

If you found this form useful, you might consider using Dugan & Repay LLP's professional services. Dugan & Repay LLP can be reached at 2198649922, emailed at , or visit his website at http://www.dr-legal.com.



Comments




Keywords: Indiana, Living Will

close