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Alam One Stop Tax and Accounting. Services, Inc

3933 Baronet Ct., San Jose, CA 95121

(408)202-0306

Estate Planning Application:

Living Will/ Power of Attorney for Health Care

If you need a Guardian or Conservator, do you name the Agent to be your Guardian or Conservator? *

Select an option

Do you want your life to be prolonged regardless of your condition?

Select an option

Do you want to receive food and fluids artificially regardless of your condition?

Select an option

Under what circumstances would you NOT want treatment to alleviate pain or discomfort?

Do you want to state any additional wishes or instructions?

Select an option

What additional health care instructions do you wish to give?

Which organs or tissues do you want to donate at your death, if any?

Select an option

How should the donated organs be used?

Can your Agent authorize an autopsy and make arrangements for disposal of your remains?

Select an option

Who do you designate as your Primary Physician?

Who will acknowledge your signature?

Select an option

Who will receive your spouse’s portion of the trust property?: Please choose who will receive your spouse’s portion of the trust property after both of you pass away. When chooosing among family friends, or charities , please make sure the percentages of all gifts add up to 100%

Who is the first Witness?

Who is the second Witness?

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