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Fill and Sign the Article 23 Right to Natural Death North Carolina General Form

Fill and Sign the Article 23 Right to Natural Death North Carolina General Form

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REVOCATION OF LIVING WILL I, ___________________________________________________________________, Declarant, having executed a Living Will on the ________ day of __________________________, 20____.Arizona Statutes §36-3202 provides that any health care directive may be revoked by doing any of the following:1. Making a written revocation of a health care directive or a written statement to disqualify a surrogate.2. Orally notifying the surrogate or a health care provider.3. Making a new health care directive.4. Any other act that demonstrates a specific intent to revoke or to disqualify a surrogate.This is my written revocation of the above referenced Living Will and I am providing a copy of this revocation to all parties to whom I provided a copy of the original instrument.DATED this the _________ day of ______________________________, 20____.WitnessPrincipalWitness Witness Name and AddressPrincipal Name and AddressName:Name:Address:Address:City:City: State: Zip:State: Zip:Phone:Phone:Witness Name and addressNameAddress:State: ZipPhone:

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