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Fill and Sign the North Carolina Declaration of a Desire for a Natural Death Form

Fill and Sign the North Carolina Declaration of a Desire for a Natural Death Form

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Open the document and fill out all its fields.
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REVOCATION OF DECLARATION OF A DESIRE FOR A NATURAL DEATH I, ___________________________________________________________________, Declarant, executed a Declaration Concerning the Use of Life Sustaining Treatment on the ________ day of ________________________, 20____, regarding my decisions and choice that my life not be prolonged by extraordinary means or by artificial nutrition or hydration if my condition were to be determined to be terminal or if I were diagnosed as being in a permanent unconscious state. South Carolina Code of Laws 44-77-80 provides that I may revoke my Declaration at any time by: 1. Defacing, tearing, obliterating, or otherwise destroying the document of declaration. 2. Written revocation, signed and dated by me, expressing my intent to revoke. 3. Oral expression by me of my intent to revoke the Declaration. 4. Written, signed, and dated revocation or by an oral revocation by my declarant's designee. 5. My execution of a subsequent declaration. This is my written revocation of my Declaration of a Desire for a Natural and is provi ded to all persons to whom I have provided a copy of my Declaration. DATED this the _________ day of ______________________________, 20____. Signature of Declarant: __________________________________________________________ Printed Name of Declarant: _______________________________________________________ Address of Declarant: ___________________________________________________________

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