Illinois Advance Directive

Information you will need

• Quality and Length of Life
• Principal Name
• Principal City, County, and State of Residence
• Principal Full Address
• Agent Name
• Agent Address
• Agent Phone Number
• Successor Agent Name, Address, and Phone Number
• Specific Limitations
• Witness Name
• Witness Address
• Principal Date of Birth
• Guardian of Person
• Authorization of Agent
• Witness Attestation
• Witness Signature Date
• Principal Signature Date
• Living Will Month and Year
• Living Will Day

Completed by the agent and the declarant and the principal.

The form includes 2 signature lines, a witness section.

The document text refers to the laws of Illinois.