I, [name], domiciled at [address] (Testator), declare this writing to be a codicil to my Will, dated [date].
1. In [clause to be changed or revoked], I bequeathed [property given] to [beneficiary].
2. I now revoke that bequest and declare and direct [change to be made].
3. I ratify and confirm my Will in all other respects.
[dated]
[signature]
Testator
This codicil to the Will of [name] (Testator) was signed and declared by him on [date] in our presence. We have subscribed our names at his request, in his presence, and in the presence of each other, as witnesses to this codicil.