Statutory Declaration in Conformance with West Virginia Natural Death Act, 16-30-3(Download)DECLARATION OF _________________Declaration made this __________ day of ______________ 20______. I, __________________, being of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially prolonged under the circumstances set forth below, do declare:If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians who have personally examined me, one of whom is my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to artificially prolong the dyin