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Kansas Living Will Form

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This is a living will declaration provided by Wichita Medical Research and Education Foundation.

Kansas Living Will Form
Kansas Living Will Form
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LIVING WILL DECLARATION
,*3(9(;065:4(+,;/0: +(@6- 465;/@,(9
Signature:
X________________________________________
(;,6-09;/ _______________________
Address: __________________________________________________________________
street city state zip
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Notary Public:
!!"!%
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or
Witnesses:
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This document is based on Kansas Statute 65-28,101 et seq. as amended
Additional forms and information are available through
Wichita Medical Research & Education Foundation
3306 E. Central, Wichita, KS 67208
316-686-7172
,7905;,+
%!
6;(9@ ,(3
Kansas Natural Death Act
www.wichitamedicalresearch.org
Kansas Living Will Form