Revocation of Statutory Equivalent of Living Will or Declaration - Kansas: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your name as the Declarant at the top of the form. This identifies you as the individual revoking the declaration.
Next, indicate the date on which you originally executed your Declaration. This is important for record-keeping and clarity.
In the section regarding methods of revocation, ensure you understand that this document serves as your written revocation. You may also want to reference KSA 65-28,104 for legal context.
Fill in the date on which you are signing this revocation. This should be current and reflect when you are making this decision.
Sign your name in the designated area to formally execute the revocation. Make sure your signature matches any previous documents for consistency.
Print your name below your signature for clarity, followed by your address to complete the form.

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