SPECIFIC DIRECTIVE CODICIL TO THE

LAST WILL AND TESTAMENT

OF ${input_50_5}

WHEREAS, on ${input_50_2} , I, ${input_50_5} , residing and domiciled at ${input_50_6_1} in the City of ${input_50_6_3} , in the County of ${input_50_6_6} and in the State of ${input_50_6_4} ${input_50_6_5} , executed my last will and testament, and; WHEREAS,, I made various instructions and bequests, and, WHEREAS,, I desire to add an additional provision to the will; I NOW PUBLISH THIS CODICIL to my LAST WILL AND TESTAMENT.

My Last Will and Testament is to be amended to add the following provisions:

IN WITNESS WHEREOF , I have set my hand and seal on ${input_50_81}

_____________________________________________
(TESTATOR/TESTATRIX SIGNATURE)

TESTATION CLAUSE

Subscribed by ${input_50_5} , Testator/Testatrix, in the presence of each of us, the undersigned witnesses, being first duly sworn, and at the same time declared by the Testator/Testatrix to us that this is the ${input_50_9} Codicil to his/her LAST WILL AND TESTAMENT, and we thereupon at his/her request, in his/her presence and in the presence of each other sign our names as Witness hereto effective ${input_50_81} .

WITNESSES SIGNATURES AND INFORMATION:

_____________________________________________
( ${input_50_87} )
${input_50_89_1}
${input_50_89_3} , ${input_50_89_4} ${input_50_89_5}

_____________________________________________
( ${input_50_92} )
${input_50_93_1}
${input_50_93_3} , ${input_50_93_4} ${input_50_93_5}

_____________________________________________
( ${input_50_96} )
${input_50_97_1}
${input_50_97_3} , ${input_50_97_4} ${input_50_97_5}

SELF-PROVING AFFIDAVIT

STATE OF ${input_50_6_4} )
)ss.
COUNTY OF ${input_50_6_6} )

IN WITNESS WHEREOF , the undersigned authority personally appearing before me on this day ${input_50_5} , the Testator/Testatrix, and the Witnesses, whose names are shown in the foregoing instrument in their respective capacities, and all of said individuals being first duly sworn by me, said Testator/Testatrix declared to me and to the aforementioned Witnesses in my presence that said instrument is the ${input_50_9} Codicil to his/her LAST WILL AND TESTAMENT and the s/he had willingly made and executed it as his/her free and voluntary act and deed for the purposes therein expressed; and the said Witnesses each on his/her oath stated to me in the presence and hearing of the said Testator/Testatrix that the said Testator/Testatrix had declared to them that said instrument is the ${input_50_9} Codicil to his/her LAST WILL AND TESTAMENT, and that s/he executed the same as such and wanted each of them to sign it as a Witness; and upon their oaths each Witness stated further that they did sign the same as a Witnesses; and upon their oaths of each Witness stated further that they did sign the same as Witnesses in the presence of the said Testator/Testatrix and at his/her request, and that said Testator/Testatrix was at the time of the age of consent of 18 years of age or over and was of sound mind.

 

Testator/Testatrix Signature:

 

___________________________________________________

 

Witness 1 Signature:

 

___________________________________________________

 

Witness 2 Signature:

 

___________________________________________________

 

Witness 3 Signature:

 

___________________________________________________

Subscribed and acknowledged before me by the said Testator/Testatrix, and subscribed and sworn to before me by the aforementioned Witnesses, on ___________________________.

 

Notary Public Signature:

 

___________________________________________________

 

My Commission Expires:

 

___________________________________________________

NOTARY ACKNOWLEDGMENT

${input_50_9} CODICIL TO THE

LAST WILL AND TESTAMENT

OF

${input_50_5}

I, ${input_50_5} , residing and domiciled in the City of ${input_50_6_3} , in the County of ${input_50_6_6} and in the State of ${input_50_6_4} , hereby make, publish and declare this to be a Codicil to my LAST WILL AND TESTAMENT dated ${input_50_2} .

My Last Will and Testament is to be amended to add the following provisions:

IN WITNESS WHEREOF, I ${input_50_5} , have to this ${input_50_9} Codicil of my LAST WILL AND TESTATMENT, subscribed my name as of _____________________________________.

_____________________________________________
(TESTATOR/TESTATRIX SIGNATURE)

 

Witness 1 Signature:

 

___________________________________________________

 

Witness 2 Signature:

 

___________________________________________________

 

Witness 3 Signature:

 

___________________________________________________

Subscribed and acknowledged before me by the said Testator/Testatrix, and subscribed and sworn to before me by the aforementioned Witnesses.

 

Notary Public Signature:

 

___________________________________________________

 

My Commission Expires:

 

___________________________________________________