Fill and Sign the I of County Kentucky Form

Signed by Testator/Testatrix: __________________________________ - 1 - REVOCATION OF LAST WILL AND TESTAMENT OF _______________________________________ BE IT KNOWN THIS DAY THAT, I, __________________________________, of ________ ______________ County, Kentucky, 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 Revoc ation 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 - Kentucky Self Proving Affidavit I, ________________________, the testator/testatrix, sign my name to this instrument this ________ day of _____________, 20______, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my revocation of last will and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. _______________________________________ Testator/Testatrix We, ___________________________________, and ___________________________, the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the testator/testatrix signs and executes this instrument as his or her last revocation of will and that he or she signs it willingly, and that each of us, in the presence and hearing of the testator/testatrix and in the presence of the other subscribing witness, hereby signs this revocation of will as witness to the testator/testatrix's signing, and that to the best of our knowledge the testator/testatrix is eighteen (18) year s of age or older, of sound mind, and under no constraint or undue influence. _____________________________________ WITNESS _____________________________________ WITNESS STATE OF KENTUCKY COUN TY OF _________________ Subscribed, sworn to and acknowledged before me by ___________________________, the testator/testatrix and subscribed and sworn to before me by __________________________, and ____________________________, witnesses, this _______ d ay of _____________, 20__. _________________________________ NOTARY PUBLIC Print name of Notary: _________________________________ Signed by Testator/Testatrix: __________________________________ - 4 - My Commission Expires: _______________________