Fill and Sign the I of County Virginia Form

Signed by Testator/Testatrix: __________________________________- 1 - REVOCATION OF LAST WILL AND TESTAMENT OF _______________________________________ BE IT KNOWN THIS DAY THAT, I, __________________________________, of ______________________ County, Virginia, 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 Revocation 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 TWONew 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 thereof 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 Revocation of Will in the presence of _____________________________ and ________________________________ who attested it at my request on this the _____ day of _____________, 20_____ at ____________________________________________________________(address), declare this to be my revocation of Last Will and Testament. ________________________________ Testator/Testatrix The above and foregoing revocation of Will of _________________________________ (name Signed by Testator/Testatrix: __________________________________- 2 - 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/her 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. _______________________________ Virginia Self Proving Affidavit - 1 - Virginia Self Proving Affidavit I, __________________________, 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 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 18 years of age or older, of sound mind, and under no constraint or undue influence. _________________________________ Testator 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 the Testator’s/Testatrix's revocation of will and that the Testator/Testatrix signs it willingly, that each of us, in the presence and hearing of the Testator/Testatrix, hereby signs this revocation of will as witness to the Testator’s/Testatrix’s signing, and that to the best of our knowledge the Testator/Testatrix is 18 years of age or older, of sound mind, and under no constraint or undue influence. __________________________________ Witness __________________________________ Witness COMMONWEALTH OF VIRGINIA COUNTY OF _______________ Subscribed, sworn to, and acknowledged before me by _________________________, the Testator/Testatrix, and subscribed and sworn to before me by _______________________ and __________________________, witnesses, this _______ day of ________________, 209__. ___________________________________ Official capacity of officer Print Name and Address of Witnesses: _____________________________________ _____________________________________ ADDRESS:____________________________ ADDRESS:____________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________