Fill and Sign the Revocation of Advance Health Care Directive Alabama Form

REVOCATION OF ADVANCE HEALTH CARE DIRECTIVE (Statutory Living Will with Health Care Proxy) I, ___________________________________________________________________ , Declarant, having executed an Advance Health Care Directive regarding certain choices and decisions I had made concerning the use of artificial life sustaining procedures on the ________ day of ________________________ , 20 ____ . Alabama Code § 22-8A-5 provides that an advance directive for health care may be revoked at any time by me by any of the following methods: (1) By being obliterated, burnt, torn, or otherwise destroyed or defaced in a manner indicating intention to cancel; (2) By a written revocation of the advance directive for health care signed and dated by the declarant or person acting at the direction of the declarant; or (3) By a verbal expression of the intent to revoke the advance directive for health care in the presence of a witness 19 years of age or older who signs and dates a writing confirming that such expression of intent was made. This is my written revocation of the above referenced Declaration and I am providing a copy of this revocation to all parties to whom I provided a copy of the original declaration. DATED this the _________ day of ______________________________, 20____. Signature of Declarant: __________________________________________________________ Printed Name of Declarant:       Address of Declarant: