Colorado Advance Directive

Information you will need

• Agent Name
• Agent Work Telephone Number
• Agent Home Telephone Number
• First Alternate Agent Name
• First Alternate Agent Home Address
• Agent Home Address
• First Alternate Agent Work Telephone Number
• First Alternate Agent Home Telephone Number
• Second Alternate Agent Name
• Second Alternate Agent Home Address
• Second Alternate Agent Work Telephone Number
• Second Alternate Agent Home Telephone Number
• Witness (1) Name
• Witness (2) Name
• Witness (1) Signature Date
• Witness (2) Signature Date
• Witness (1) Address
• Witness (4) Address
• Witness (3) Address
• Witness (2) Address
• Declarant Signature Date
• Principal Signature Date
• Principal Address
• Additional Instruction

…and 15 more fields in the PDF.

Completed by the agent and the declarant and the provider.

The form includes 6 signature lines, a witness section.