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Codicil To Will

This is my (first) (second) (third) CODICIL to the will dated [Date] of [Enumerate] of the following address [Address], in the city of [City].

1. I revoke clause [--] of my will and substitute the following clause for it:

2. In all other respects I confirm my will.

In witness to which CODICIL, I have signed my name to it below on [Date].

Signed by me:

in our presence and by us in (his) (her) presence and in the presence of each other:

Witness # 1:

(Printed name):

Address:

Occupation:

Witness # 2:

(Printed name):

Address:

Occupation:

________________________

(Your signature)

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss:

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(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 signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)