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                                                                                  , being of sound mind and at least eighteen years of age,

direct that my life shall not be artificially prolonged under the circumstances set forth below and hereby declare that:

               1. If at any time my attending physician and one other qualified physician certify in writing that:
                    a. I have an injury, disease, or illness which is not curable or reversible and which, in their judgment,
                          is a terminal condition; and
                    b. For a period of seven consecutive days or more, I have been unconscious, comatose, or otherwise
                         incompetent so as to be unable to make or communicate responsible decisions concerning my
                         person; then
                    I direct that, in accordance with Colorado law, life-sustaining procedures shall be withdrawn and
                    withheld pursuant to the terms of this declaration; it being understood that life-sustaining procedures
                    shall not include any medical procedure or intervention for nourishment considered necessary by the
                    attending physician to provide comfort or alleviate pain. However, I may specifically direct, in accord-
                    ace with Colorado law, that artificial nourishment be withdrawn or withheld pursuant to the terms of
                    this declaration.

           2. In the event that the only procedure I am being provided is artificial nourishment, I direct that one of the
                following actions be taken:
                a. Artificial nourishment shall not be continued when it is the only procedure being provided; or

                  b. Artificial nourishment shall be continued for                                       days when it is the only procedure
                      being provided; or

                        Artificial nourishment shall be continued when it is the only procedure being provided.

           3. I execute this declaration, as my free and voluntary act on


    The foregoing instrument was signed and declared by
 to be his/her declaration, in the presence of us, who, in his/her presence, in the presence of each other, and at his/her
 request, have signed our names below as witnesses, and we declare that, at the time of the execution of this instru-
 meant, the declarant according to our best knowledge and belief, was of sound mind and under no constraint or undue
 influence .

    Dated at                                                   , Colorado, this             day of                                     19

                                                     Signature of Witness                                                              Signature of Witness

                    Print or Type Name and Address                                                   Print far Type Name and Address

                         STATE OF COLORADO

                               County of                                             ss

    SUBSCRIBED and sworn to before me by                                                                                      , the declrarant, and
                                                               , and                                                            , witnesses, as the
 voluntary act and deed of the declrarant, this                                  day of                                        , 19

 Witness my hand and seal.
                                                   Attorney William Bronchick’s
                                                 WEALTH PROTECTION LIBRARY
                                                   Will Show You How to Protect
                                                  Yourself, Your Business and Your
                                                  Family from Lawyers, Taxes and
Complete with top-notch, state-specific
     legal forms on CD-ROM!                          Other Financial Disasters!
   Ask for Special Discounts When You Purchase the Entire Set!
This 130 manual and four video tape course is loaded with great, practical information for protecting and preserving your
assets from lawsuits, liability and financial disaster. Tons of practical advice for setting up your business and real estate
holdings for maximum lawsuit protection and minimum tax liability. Learn why offshore trusts may be better than they sound,
why living trusts won’t protect your assets and how to avoid common liability issues. Case studies, sample forms and
resource directory included. New for 2002!

This home study course will show you STEP-BY-STEP how to form and maintain a corporation in any state. Contains
detailed explanations of keeping corporate minutes, maintaining formalities and a “bulletproof” paper trail for loans,
expenses, distributions and contributions. Covers when (and when not) to use NV & DE corporations. This course will save
you THOUSANDS in taxes and attorney fees, and will give you dozens of practical tips for running your corporation.
Complete with state-specific legal forms on CD-ROM, “quick –start” audiotape and 30 min. video. Revised 2002

This one-of-a-kind course will show you STEP-BY-STEP how to form and use land trusts to keep your ownership of
property, mortgages & options private and free from public intrusion. Learn the secrets of protection title from liens,
assuming “non assumable” loans, avoiding probate of property and much more! Also covers “personal property” trusts for
keeping notes, cars, boats, bank accounts and other property secret. Contains references to the laws to all 50 states (sorry,
not valid in TN & LA), “quick-start” audiocassette, state-specific legal forms CD-ROM and video tape. Revised 2002land

VOLUME FOUR: LLCs & FAMILY LIMITED PARTNERSHIPS . . . . . . . . . . . . . .$249.00
This course will show you STEP-BY-STEP how to form and maintain a limited liability company or family limited partnership
to protect and legally “judgment-proof” your assets. Contains detailed explanations of keeping records, maintaining
formalities and the latest tax and liability issues concerning LLCS. This course will save you THOUSANDS in attorney’s fees
and give you dozens of practical tips for starting and running an LLC or family limited partnership. Comes complete with
“quick-start” audiocassette, legal forms CD-ROM with filing forms for all 50 states and 30 min video tape. Revised 2002.

   “EZ” Customer Order Form                                                                Telephone Orders:
                                                                                           Toll Free 1-800-655-3632

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                                                                                           2620 S. Parker Rd #272
                                                                                           Aurora, CO 80014

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