Revocation of Statutory Equivalent of Living Will or Declaration - Iowa 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name as the Declarant in the designated field. Ensure that it matches the name on your original Declaration.
3. In the section regarding the date of your original Declaration, input '10th day of January, 2005' to reference when you executed it.
4. Clearly state your intent to revoke by writing a brief statement, such as 'This is my written revocation...' in the provided area.
5. Fill in the date of this revocation at the bottom, ensuring it reflects when you are completing this document (e.g., '1st day of August, 2007').
6. Sign and print your name in the respective fields to validate your revocation. Make sure your signature is clear and legible.
7. Lastly, provide your address in the designated field to complete the form accurately.

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