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Iowa living will form
Download the August 2026 Iowa Living Will Declaration, a suggested form based on Iowa Code § 144A.3(5), for directing that life-sustaining procedures be withheld or withdrawn in the circumstances stated in the declaration. Get the form in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific living will declaration packet, reviewed against the current Iowa statute and ready for instant secure access.
Tracks the optional § 144A.3(5) declaration rather than using a generic national form.
Includes stacked qualified-witness blocks and an alternative Iowa notarial acknowledgment.
Complete the form on your device, then print and sign with witnesses or an Iowa notary.
This download includes 1 document in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete form text below before purchasing. Your licensed Word and fillable PDF download is delivered after checkout.
IOWA LIVING WILL DECLARATION
(Iowa Code § 144A.3)
NOTE TO DECLARANT
This suggested form tracks the optional declaration in Iowa Code § 144A.3(5). Date and sign it, or direct another person to sign for you. Then choose one execution path: sign before two qualified witnesses who are present with each other and with you, with at least one witness not related to you within the third degree by blood, marriage, or adoption, or acknowledge it before a notarial officer within Iowa under chapter 9B. A witness cannot be under age eighteen, your attending health care provider on the execution date, or an employee of that provider.
DECLARATION
If I should have an incurable or irreversible condition that will result either in death within a relatively short period of time or a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery, it is my desire that my life not be prolonged by the administration of life-sustaining procedures.
If I am unable to participate in my health care decisions, I direct my attending physician to withhold or withdraw life-sustaining procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain.
Optional additional directions:
________________________________________________________________________
________________________________________________________________________
________________________________________________
Signature of Declarant
________________________________________________
Printed Name
____________________________
Date
(OR)
TWO-WITNESS EXECUTION
The witnesses sign in the presence of each other and the declarant. At least one witness must not be related to the declarant within the third degree by blood, marriage, or adoption.
First Witness
________________________________________________
Signature of First Witness
________________________________________________
Printed Name of First Witness
____________________________
Date
Second Witness
________________________________________________
Signature of Second Witness
________________________________________________
Printed Name of Second Witness
____________________________
Date
(OR)
IOWA NOTARIAL ACKNOWLEDGMENT
State of Iowa, County of _________________________
This record was acknowledged before me on ____________________ by ____________________________.
________________________________________________
Signature of Notarial Officer
________________________________________________
Printed Name and Title
________________________________________________
Commission Number and Expiration, if applicable
Affix seal:
Legal currency, verified
This Iowa declaration lets you direct that life-sustaining procedures be withheld or withdrawn in the circumstances stated in Iowa Code chapter 144A.
Tracks the optional form language in Iowa Code § 144A.3(5). The statute says a declaration may, but need not, use this form. It is not a government publication.
Date and sign the declaration, or direct another person to sign for you. Then use either two qualified witnesses who are present with each other and with you, or an Iowa chapter 9B notarial acknowledgment. At least one witness must not be related to you within the third degree by blood, marriage, or adoption.
The declaration is not in effect during a pregnancy while the fetus could develop to live birth with continued life-sustaining procedures. It is not an out-of-hospital do-not-resuscitate order, which Iowa Code § 144A.7A addresses separately.
This declaration does not appoint an agent. Use a separate Iowa Durable Power of Attorney for Health Care if you want to name someone to make health care decisions for you.
This form is not legal advice. Consider speaking with an Iowa licensed attorney about your situation.
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No. Iowa Code § 144A.3(5) says a declaration may, but need not, use the statutory form. This suggested form tracks that language.
Date and sign it, or direct another person to sign for you, then use either two qualified witnesses present with each other and with you or an Iowa chapter 9B notarial acknowledgment.
Witnesses must be adults and cannot be your attending health care provider on the execution date or that provider’s employee. At least one cannot be related to you within the third degree by blood, marriage, or adoption.
No. Use a separate Iowa Durable Power of Attorney for Health Care to appoint a health care decision maker.
No. Iowa Code § 144A.7A separately governs out-of-hospital do-not-resuscitate orders.
Under § 144A.6(2), the declaration is not in effect while a fetus could develop to live birth with continued life-sustaining procedures.