South Dakota Advance Directive

Information you will need

• Principal City
• Principal Street Address
• Principal County
• Initial: Other
• Check: Other
• Agent Address
• Agent Phone Number
• Successor Agent Name
• Successor Agent Address
• Successor Agent Phone Number
• Other Treatment
• Date Completed
• Notary Only: State
• Notary Only: County
• Notary Only: Date
• Notary Only: Principal Name
• Notary Only: Name
• Notary Only: Commission Expiration
• Principal Name
• Principal SSN
• Initial: Coma
• Check: Coma
• Initial: Communication
• Check: Communication

…and 30 more fields in the PDF.

Completed by the agent and the principal and the provider.

The form includes 3 signature lines, a notary acknowledgment, a witness section.

The document text refers to the laws of South Dakota.