DIY Legal Forms

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WHEREAS, on the ________ day of ________, [Month] 20 __, I ________ [Name] of ________ [Address], did hereby execute my last will and testament, and;

WHEREAS, I made various directives and inheritances, and,

WHEREAS, I desire to revoke said inheritances

I NOW MAKE PUBLIC THIS CODICIL to my last will and testament of:

I confirm all parts and demonstrations of said will, except that, I:

annul, retract and invalidate that certain inheritance to ________ [Name] of ________ [Address], and that this inheritance shall pass with the remainder of the estate.



[Testator (Name)]

I herewith affix my signature to this codicil on this ________ day of ________, 20 __ at ________, in the presence of the following witnesses, who witnessed and subscribed this codicil at my request, and in my presence.

Attestation Clause

On the date above written, ________ [Name], well known to us declared ________ [Declaration], to us, and in our presence, that this document, consisting of __ pages, is a codicil to their last will and testament, and ________ [Name], then signed this document in our presence, and at ________ request we now sign this codicil as witnesses in each other's presence. Further that ________ [Name], appeared to us to be of sound mind and body and of lawful age, and under no undue sway.

First Witness: [Signature of Witness]

[Name of Witness]

[Address of Witness]

Second Witness: [Signature of Witness]

[Name of Witness]

[Address of Witness]

Third Witness: [Signature of Witness]

[Name of Witness]

[Address of Witness]


State of ________)


County of________)

On ________, before me, ________, Notary Public, personally appeared ________, who proved to me on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signatures on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Who after being having duly sworn or affirmed to tell the truth, stated:

1. That ________ declared this instrument to be a codicil to their last will and testament to the witnesses.

2. That ________ signed this instrument in their presence.

3. That the witnesses signed as witnesses in the presence of and each other.

4. That ________ is well known to the witnesses, and the witnesses believe to be of lawful age, of sound mind and under no undue influence or constraint.

I certify under the PENALTY OF PERJURY under the laws of the State of _________ that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.


Name of Notary

Notary Public

My Commission Expires