Missouri Living Will Form

The Missouri living will is a legal document that an individual may utilize to set fourth  to inform family, friends and Medical providers as to their wishes in the event the individual (Principal) should ever face a time when they are in end of life circumstances. Unlike many states documents, the State of Missouri living will, is basic, but is what is acceptable. If the Principal would like to expand on their wishes with regard to other aspects of how they would wish their medical providers treat pain etc… prior to the point that the Principal is no longer able to make their own decisions known to Doctors or family, enter added sheets. provide the explanations and wishes, sign and date each sheet and be certain to have your witnesses sign all of the sheets as well as the document. This document must be witnessed once completed by the Principal, it must be witnessed. The Principal must complete the document while they are of sound mind and should be aware that they may change or revoke all or any part of this document at their discretion.

Laws – 459.010, et seq. Declaration; Life Support

How to Write

Step 1 – The Principal/Declarant must first download the document  –

  • The Principal must carefully read the Declaration paragraph at the top of the page
  • If in agreement, provide a date of execution of the document by entering the date in dd/m/yy format
  • Printed name of the Declarant
  • Declarant’s signature
  • Complete address

Step 2 – Witness signatures – Prior to providing signatures, the witnesses must read and agree with the witness statement. Enter the following:

  • Witnesses must submit their respective information –
  • Witnesses Signatures
  • Printed names
  • Complete addresses

Step 3 – Revocation Provision –

  • This section should be left to only be completed in the event the Principal would like to revoke the document at a future date

Step 4 – Durable Power of Attorney for Health Care – If the Principal would like to appoint someone they trust to speak on their behalf, when they are no longer able to do so, this section must be completed as follows:

  • Enter the Principal’s full name
  • Address
  • AND
  • Full name of the designated attorney in fact/agent
  • Address
  • Home Phone
  • Work Phone

Alternate Agent – In the event the initial agent is unable to serve, the Principal may select an alternate by providing the following information:

  • Submit the full name of the alternate agent
  • Address
  • Home Phone
  • Work Phone
  • The Principal must read the next two paragraphs – This addresses your protection to ensure that the powers provided to the agent will take place only with the signatures of two physicians willing to state that the Principal is completely unable to make their own decisions any longer
  • In the 3d paragraph enter the name of the Principal
  • Date the signature in dd/m/yy
  • Enter the Principal’s signature

Notarization – Once the document is completed and witnessed, the notary public will acknowledge the document and Principal’s signature and shall affix their official seal

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