Alabama Living Will

Date Form

Date Signed

Month Signed

Year Signed

Principal’s Name

Principal’s Street

Principal’s City Address

Principal’s County Address

Principal’s State Address

State Law

Last Four Ssn Digits

State Your End Of Life Desires

Agent’s Name

Agent’s City Address

Agent’s State Address

Agent’s Contact Number

Successor’s Name

Contact Number

Successor’s City Address

Successor’s State Address

Date

Month

Year

Name Of The Witness

Witness City Address

Witness State Address

Depending On Your State, Signatures May Be Required By And With Authorized/respective Persons.

I Understand