REVOCATION OF DECLARATION OF LIVING WILL I, hereby revoke my Declaration (Living Will) regarding withholding or withdrawal of life-sustaining treatment in the event I am in a terminal condition which will result in my death in a short period of time. This revocation is effective immediately and must be communicated to my attending physician and other health care providers as soon as possible. Dated this day of , 20 . __________________________________ (Signature) American LegalNet, Inc. www.FormsWorkFlow.com