Fill and Sign the Changing Will with Codicil to Will Adding New Bequest and Republishing Form

Codicil Number ______ to Last Will and Testament of _____________________ (Name of Testator) I, ___________________ (Name of Testator) , of ___________________ (Name of County) County, _________________ (Name of State) , declare this to be a Codicil to my Last Will and Testament dated ______________ (date) . This Codicil amends or supplements my Will only as provided herein. Except as amended or supplemented, my Will shall remain in full force and effect. Article I I revoke Article ______ (number) of my Last Will and Testament. Article II In Article ______ (number) of my Last Will and Testament I stated: I make the following gifts of money: To the _______ (number of gifts) gifts made in the _____ (number) s ubsequent paragraphs, I add a _______ (number of new paragraph) paragraph making another gift as follows which should be numbered _____ (number) : ______ (Number). To __________________ (Name of Beneficiary) , presently residing at ___________________________________________________________________________ (street address, city, state, zip code) , $_____________, if (he or she) survives me. If (he or she) does not so survive me, the gift shall lapse and become a part of the residue of my estate. Article III I confirm and republish my Will dated ______________ (date) in all respects other than those above-mentioned. IN WITNESS WHEREOF, I have hereunto subscribed my name this the day of _____________, 20____. ____________________________ (Printed Name of Testator) ____________________________ (Signature of Testator) This instrument was, on the day and year shown above, signed, published and declared by ______________________ (Name of Testator) , to be his Last Will and Testament in our presence, and we, at his request, have subscribed our names hereto as witnesses in his presence and in the presence of each other. _______________________ (Printed Name of Witness) _______________________ (Signature of Witness) _______________________ (Printed Name of Witness) _______________________ (Signature of Witness) State of _____________ County of ______________ Affidavit of Subscribing Witnesses This day personally came and appeared before me, the under-signed authority at law in and for said jurisdiction, _________________ (Name of Witness) and ___________________ (Name of Witness) , the two subscribing witnesses to that certain instrument of writing purporting to be a Codicil to the Last Will and Testament of ___________________ (Name of Testator), a resident of ____________________________________________ (Name of City, County and State) , each of whom, having been first duly sworn, makes oath that the said ______________________ (Name of Testator) , signed, published and declared the original of said instrument as his Codicil to his Last Will and Testament on the __________________ (date) , the day and date of said instrument, in the presence of said two affiants, both of whom were the subscribing witnesses to said instrument; that said Testator was then of sound and disposing mind and memory and above the age of twenty-one (21) years; and each of the said two subscribing witnesses subscribed and attested said instrument as witnesses to the signature and publication thereof, at the special instance and request, and in the presence of the said Testator and in the presence of each other. ______________________ (Printed Name of Witness) ______________________ (Signature of Witness) ______________________ ______________________ (Address of Witness) ______________________ (Printed Name of Witness) ______________________ (Signature of Witness) _______________________ _______________________ (Address of Witness) SWORN to and subscribed before me, this the _____ day of day of _______________, 20_____. ______________________ NOTARY PUBLIC My Commission Expires: _____________________