Fill and Sign the Following is a Sample Codicil Only Not an Entire Will 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. I. I direct that my Last Will and Testament (identified above) be amended by deleting paragraphs (designation of paragraphs) _____________________ of Article _____ (number)appearing on pages (list of page numbers) ________________________ in their entirety and inserting in lieu of those the following Paragraphs to Article _____ (number): (Text of new paragraphs) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 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)
(printed name of witness)(signature of witness) in witness whereof, we have hereunto subscribed our names hereto as witnesses in our presence and in the presence of each other, and hereby declare that we understand that the will has been declared to be a codicil to it by a judgment, duly entered, before us; and we further declare that (printed name of testator)—(signature of witness) (printed name of witness) this instrument (original in the hands of the signatory hereinafter named) was, on the day and year shown above, signed, published and declared by (name of signatory hereinafter named) 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, and we hereby make such declaration in our presence and in the presence of each other that if, when we shall have done according to our will, this instrument shall be found to be void or voidable in any way by reason of any errors found in it, we are nevertheless willing and desirous to accept the last will, which we make the basis of the new will, and which will be binding on us and our heirs. 2. I direct that my last will and testament be amended by inserting on each page a paragraph (letter designation) of article (number) appended: (letter designation) in witness whereof I have hereunto subscribed my name this day of, 20. (printed name of decedent) (signed) (printed name of surviving spouse if living) I do hereby authorize and direct my executor and administrator to make and record in the following manner the said first paragraph of the said last will and testament : (printed name of executor) (printed name of administrator) (printed name of parent or legal guardian if living) in witness whereof, I have hereunto subscribed my name this day of 20. , and I hereunto set my hand and seal. (signed) (printed name of executor) (signed) (printed name of administrator)(signed) (printed name of parent or legal guardian); and I hereunto set my hand and seal. (signed) (printed name of parent or legal guardian) (signed) (print name of testator) (signed) (printed name of testator) if any amendment to my will is requested by any one person, before