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Fill and Sign the Revocation of Advance Healthcare Directive Wyoming Form

Fill and Sign the Revocation of Advance Healthcare Directive Wyoming Form

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REVOCATION OF ADVANCE HEALTHCARE DIRECTIVE (Wyoming Statutes 35-22-404) I,       , Declarant, executed an Advance Healthcare Directive (Living Will) on the       day of       , 20       . Wyoming Statutes 35-22-404 provides that an Advance Healthcare Directive (Living Will) can be revoked by me at any time and in any manner that communicates an intention to revoke. Oral revocations shall be documented later by a writing signed by me or a witness to my revocation. This is my written revocation of my Advance Healthcare Directive (Living Will) and is provided to all persons to whom I have provided a copy of my Advance Healthcare Directive (Living Will). DATED this the       day of       , 20       . Signature of Declarant: __________________________________________________________ Printed Name of Declarant:       Address of Declarant:      

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