Fill and Sign the Written Revocation Form

Signed by Testator/Testatrix: __________________________________ - 1 - REVOCATION OF LAST WILL AND TESTAMENT OF _______________________________________ BE IT KNOWN THIS DAY THAT, I, __________________________________, of ______________________ County, California, 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 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. _______________________________ California Self -Proving Affidavit - 1 - California Self Proving Affidavit State of California County of ______________ I, __________________________, the testator/testatrix, sign my name to this instrument this ___ day of __________, 20___, and being first duly sworn, do hereby decla re 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 years of age or ol der, of sound mind, and under no constraint or undue influence. _____________________________ Testator/Testatrix We, ___________________________ and _______________________, the witnesses, sign our names to this instrument, an d at least one of us, being first duly sworn, does hereby declare, generally and to the undersigned authority, that the testator/testatrix signs and executes this instrument as his/her revocation of last will and that he/she signs it willingly, and that ea ch 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 eighteen years of age or older, of sound mind, and under no constraint or undue influence. ______________________________ Witness ______________________________ Witness The foregoing instrument was acknowledged before me this the _______ day of __________, 20_______ by ___________________ _________________________________, Testator/Testatrix, _________________________________, Witness and _________________________________, Witness, and was sworn to and subscribed before me on said date by said Testator/Testatrix and both witnesses. _______ ________________________ NOTARY PUBLIC Print Name: _______________________ My Commission Expires: ______________________ Serial Number, if any: _______________ California Self -Proving Affidavit - 2 -