Updated August 03, 2023
An Indiana living will declaration, or “Form 55316,” establishes a person’s intent to withhold life-sustaining procedures. This would only come into effect when a person has an incurable injury, disease, or illness. It’s recommended to also complete a Medical Power of Attorney to elect an agent to carry out the wises located in this declaration.
Life-Prolonging Procedures (Form 55315) – Use for a person who wishes to extend their life as long as possible.
Laws
- Signing Requirements – Two (2) witnesses or a notary public (IC 16-36-4-8).
- Statute – IC 16-36-4-10
How to Write
Download: PDF, MS Word (.docx), OpenDocument
Step 1 – Declaration – Download the form and begin by entering:
- Date of the declaration in dd/mm/yyyy format
Step 2 – Declarant/Principal Review of Statement – The Declarant must carefully review the statements provided on the form. If the Declarant understands and is in agreement, provide a response to the statement, by initialing the appropriate lines preceding each statement (if any)
Step 3 – Declarant/Principal Signature – The Declarant must read the final paragraph of this section. If in agreement, the Declarant will enter the following:
- The Declarant’s Signature
- Enter the Declarant’s City, County and State of Residence
Step 4 – Witness Signatures or Notary Acknowledgment – This document will require the review and signatures of two (2) witnesses or the acknowledgment of a notary public. Any witnesses must carefully read the information in this section. If in agreement, the witnesses must enter the following into the form:
Witness 1 –
- Witness’s Signature
- Date the signature in mm/dd/yyyy format
Witness 2 –
- Witness’s Signature
- Date the signature in mm/dd/yyyy format