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Begin by entering the date of declaration in the format ___ day of _____, 20___ (month, year).
Fill in your full name where indicated, ensuring you are at least eighteen years old and of sound mind.
Review the conditions under which you wish to refuse life-prolonging procedures. Initial your choice regarding artificially supplied nutrition and hydration.
Sign the document at the designated area, confirming your understanding of this declaration.
Provide details for two witnesses, including their names, addresses, and dates of signing. Ensure they meet the criteria outlined in the form.
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