Wyoming Living Will

I. Declaration

I, [YOUR NAME], residing at [YOUR COMPANY NAME], being of sound mind and acting of my own free will, do hereby declare this document to be my Living Will, directing the course of my medical treatment and end-of-life care if I am unable to communicate my wishes.

II. Statement of Intent

1. I understand that medical circumstances may arise where I am unable to make decisions regarding my healthcare.

2. I intend to express my preferences regarding life-sustaining treatments in advance to guide my healthcare providers and family members.

III. Directive

Following my beliefs and desires, I hereby direct that:

1. If I am diagnosed with a terminal condition and am unable to communicate my wishes, I do not wish to receive life-prolonging treatments that only serve to artificially prolong the process of dying.

2. Specifically, I do not consent to the use of:

   • Ventilator or mechanical breathing assistance.

   • Artificial hydration through intravenous fluids or feeding tubes.

   • Feeding tubes for artificial nutrition.

3. I understand that this directive applies even if the absence of such treatments may hasten my death.

IV. Healthcare Proxy

If I am unable to make medical decisions for myself, I designate the following individual to serve as my healthcare proxy and make healthcare decisions on my behalf:

1. Name of Healthcare Proxy: [Full Name]

   Relationship to Me: [Relationship]

   Contact Information: [Phone Number, Email Address]

2. Name of Alternate Healthcare Proxy (optional): [Full Name]

   Relationship to Me: [Relationship]

   Contact Information: [Phone Number, Email Address]

V. Revocation

I hereby revoke any prior Living Will or Advance Directive that I may have executed.

VI. Signature and Witnesses

I sign this Living Will on this [DATE] in the presence of the following witnesses, who attest to my signature in their presence and at my request:

Testator

[YOUR NAME]

[YOUR COMPANY ADDRESS]

Witness #1

Name: [WITNESS NAME 1]

Address: [WITNESS ADDRESS 1]

Witness #2

Name: [WITNESS NAME 2]

Address: [WITNESS ADDRESS 2]

VII. Notarization (Optional)

Acknowledged before me on [DATE] by [YOUR NAME], the declarant, and witnessed by the undersigned witnesses

Notary Public Name: [NOTARY'S NAME]

Commission Expires: [EXPIRATION DATE]

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