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Codicil To Will

This is my (first) (second) (third) CODICIL to the will dated ______ of __________ of the following address, ________ in the city of ________ the State of ___.

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 _______________, 20 __.

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)