A general form of a codicil.

I, _________[name of testator], _________[if known by other names, add: also known as _________ and _________], _________[if married woman, add: formerly known as _________(maiden name)], a resident of _________[address], _________ County, _________[state], declare that this is the _________[second or as the case may be] codicil to my last will and testament, which is dated _________, _________[if one or more previous codicils is to be republished, add: and the _________(first, or as the case may be) codicil thereto, dated _________]. I. I revoke Paragraph _________ of my last will and testament _________[if desirable under the circumstances, add: which reads as follows: _________]. _________[If provision revoked is to be modified, add: In place of this revoked provision I substitute the following: _________]. II. In Paragraph _________ of my last will and testament I stated: _________[insert the exact language being referred to, such as: "I make the following gifts of money:"]. _________[Insert language describing desired change, such as: To the two gifts made in the two subparagraphs thereafter, I add a third subparagraph making a third gift as follows: 3. To _________, presently residing at _________(address), _________ County, _________ (state), the sum of $_____, if _________(he or she) survives me _________(if desired, add: for _________ days). If _________(he or she) does not so survive me, the gift shall lapse and become a part of the residue of my estate.] III. I hereby confirm and republish my will dated _________, _________[if previous codicil is to be republished, add: and my codicil to that will dated _________] in all respects other than those abovementioned. I subscribe my name to this codicil on _________[date], at _________[address], _________ County, _________[state], in the presence of _________, _________, and _________, attesting witnesses, who subscribe their names to this codicil on _________[date] at my request and in my presence. [Signature] ATTESTATION CLAUSE On the date last above written, _________[testator's name], known to us to be the person whose signature appears at the end of this codicil, declared to us, the undersigned, that the foregoing instrument, consisting of _________ pages, including the page on which we have signed as witnesses, was the _________[number, such as: second] codicil to _________[his or her] will dated _________. _________[He or She] then signed the codicil in our presence and, at _________[his or her] request, in _________[his or her] presence and in the presence of each other, we now sign our names as witnesses.

_________[Signature], _________[Signature], _________[Signature],

residing at residing at residing at

_________[Street, city, state] _________[Street, city, state] _________[Street, city, state]