Fill and Sign the I of County Kansas Form

Signed by Testator/Testatrix: __________________________________ - 1 - REVOCATION OF LAST WILL AND TESTAMENT OF _______________________________________ BE IT KNOWN THIS DAY THAT, I, __________________________________, of ________ ______________ County, Kansas, being of legal age and of sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue influence of any person, do make, declare and publish this to be my Revocation of Will. ARTICLE ONE Revocat ion of all Prior Wills I hereby revoke any and all wills and codicils made by me prior to the date of this written revocation, including, but not limited to the following: 1. Will dated _________________. ARTICLE TWO New Will I may make a new will and this revocation is not intended to revoke any will I may make in the future, including any will I may make on the date of this revocation. In other words, if I elect to make a new will on the date of this revocation, my new will is not revoked by this instrument and shall remain in full force. ARTICLE THREE Testamentary Intent It is further my intent by execution of this revocation that no prior will of mine shall be probated, in whole or in part, nor shall any provisions there of be revived by any subsequent will's express or implied revocation. Nor shall any court ruling as to the validity of any will I may make in the future act to revive any revoked will of mine. I, ________________________________, having signed this Revoc ation of Will in the presence of _____________________________ and ________________________________ who attested it at my request on this the _____ day of _____________, 20_____ at ____________________________________________________________(address), decl are this to be my revocation of Last Will and Testament. ________________________________ Testator/Testatrix Signed by Testator/Testatrix: __________________________________ - 2 - The above and foregoing revocation of Will of _________________________________ (name of testator/testatrix) was declared by ________________ _____________________ (name of testator/testatrix) in our view and presence to be his/her revocation of Will and was signed and subscribed by the said ______________________________________ (name of testator/testatrix) in our view and presence and at his/h er request and in the view and presence of _____________________________ (name of testator/testatrix) and in the view and presence of each other, we, the undersigned, witnessed and attested the due execution of the revocation of Will of __________________ _________________ (name of testator/testatrix)on this the _____day of ___________________, 20__. _____________________________________ __________________________________________ Witness Signature Witness Signature Print Name: _____________________________ Print Name: _________________________________ Address: _______________________________ Address: _________________________ ___________ ______________________________________ ___________________________________________ Telephone No. __________________________ Telephone No. _______________________________ Signed by Testator/Testatrix: __________________________________ - 3 - Kansas Self -Proving Affidavit State of Kansas County of ___________ Before me, the undersigned authority, on this day personally appeared ___________________________, ___________________________, and ________________ ____, known to me to be the testator/testatrix and the witnesses, respectively, whose names are subscribed to the annexed or foregoing instrument in their respective capacities, and, all of said persons being by me first duly sworn, said __________________ _____________, Testator/Testatrix, declared to me and to the said witnesses in my presence that said instrument is the testator's/testatrix’s revocation of last will and testament, and that the Testator/Testatrix had willingly made and executed it as the testator's/testatrix’s free and voluntary act and deed for the purposes therein expressed; and the said witnesses, each on the witness' oath stated to me, in the presence and hearing of the said Testator/Testatrix, that the said Testator/Testatrix had decla red to them that said instrument is the testator’s/testatrix’s revocation of last will and testament, and that the testator/testatrix executed same as such and wanted each witness to sign it as a witness; and upon their oaths each witness stated further th at they did sign the same as witnesses in the presence of each other and in the presence of the testator/testatrix and at the testator’s/testatrix’s request, and that said testator/testatrix at that time possessed the rights of majority, was of sound mind and under no restraint. _________________________(Testator/Testatrix) _________________________(Witness) _________________________(Witness) Subscribed, acknowledged and sworn to before me by __________, testator/testatrix, and __________ and __________, witnesses, this _____ day of __________, A.D. __________. (Seal) (Signed) _______________________________ ______________________________________ Official capacity of officer