Arizona Living Will

Information you will need

• Witness/Notary Printed Name
• Witness Printed Name
• No Life Sustaining Treatment
• Irreversible Coma or Persistent Vegetative State
• No CPR
• No Artifical Food and Fluids
• Do Not Take to Hospital
• Pregnancy
• Use All Medical Care
• Prolong Life
• No End of Life Care Special Instructions Attached
• End of Life Care Special Instructions Attached
• Principal Name
• Principal Date of Birth
• Principal Address
• Principal Phone Number
• Principal Email Address
• Principal Signature Date
• Witness/Notary Signature Date
• Witness Signature Date
• Witness Address
• Notary Only: Year
• Notary Only: County
• Notary Only: Principal Name

…and 5 more fields in the PDF.

Completed by the principal and the agent.

The form includes 4 signature lines, a notary acknowledgment, a witness section.