Georgia Advance Directive

Information you will need

• Principal Date of Birth
• Principal Signature Date
• Principal Name
• Agent Name
• Agent Address
• Agent Home Telephone Number
• Agent Work Telephone Number
• Agent Cell Phone Number
• Agent Email Address
• Back Up Agent Name
• Back Up Agent Address
• Back Up Agent Telephone Number
• Back Up Agent Email Address
• Second Back Up Agent Name
• Second Back Up Agent Address
• Second Back Up Email Address
• Authorization of Autopsy
• No Power to Make Disposition of Principal's Body
• No Power to Donate Organs
• Final Disposition of Body
• Final Disposition of Body Designee Name
• Final Disposition of Body Designee Address
• Final Disposition of Body Designee Telephone Number
• Final Disposition of Body Designee Email Address

…and 29 more fields in the PDF.

Completed by the agent and the declarant and the provider.

The form includes 3 signature lines, a witness section.