New York Advance Directive

Information you will need

• Agent Name
• Alternate Agent Name
• Proxy Expiration
• Limitations
• Principal Address
• Organ Donation
• Specific Organs
• Organ Limitations
• Donation Description
• Organ/Tissue Limitations
• Witness (1) Name
• Witness (2) Name
• Witness (1) City, State, ZIP Code
• Witness (2) City, State, ZIP Code
• Principal Name
• Other Directions
• Witness (1) Signing Date
• Witness (2) Signing Date
• Principal Signing Date
• Witness (1) Street Address
• Witness (1) State
• Witness (2) State
• Witness (1) City
• Witness (2) City

…and 4 more fields in the PDF.

Completed by the agent.

The form includes 1 signature line, a witness section.

The document text refers to the laws of New York.