Alabama Advance Directive

Information you will need

• Principal Signature Date
• Principal Date of Birth
• Witness Name
• Witness Signature Date
• Parties Requiring Consultation
• First Proxy Name
• Second Proxy Name
• Second Proxy Signature Date
• First Proxy Signature Date
• First Proxy Relationship
• First Proxy Address
• First Proxy City
• First Proxy State
• First Proxy ZIP Code
• First Proxy Phone Number
• Second Proxy Relationship
• Second Proxy Address
• Second Proxy City
• Second Proxy State
• Second Proxy ZIP Code
• Second Proxy Phone Number
• Other Directions
• Principal Name
• Life Sustaining Treatment

…and 6 more fields in the PDF.

The form includes 6 signature lines, a witness section.

The document text refers to the laws of Alabama.