CODICIL TO THE LAST WILL AND TESTAMENT

OF
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THIS IS THE CODICIL (the “Codicil”) to the Last Will and Testament (my “Last Will”) which
was made on _____ by me, ________ Resident of the following address:
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Preliminary Declaration

I hereby declare that I have the legal capacity, the sound mind and disposing memory at the
making of the Codicil. I further declare that I am making this Codicil voluntarily and without any
undue influence from whatsoever.

Amendments to My Last Will

1. My Last Will is hereby amended to include the following provisions:

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2. I hereby modify my Last Will by deleting the following provisions:
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3. I hereby modify my Last Will to reflect the following change:
The following provision is hereby revoked:
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And is replaced with the following provision:

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4. I hereby republish my Last Will dated _______ in all respect other than those mentioned
in this Codicil.

Insufficient Estate

5. If the value of my estate is insufficient to fulfill all of the bequests described in my Last
Will or Codicil, then I give my executors the authority to decrease each bequest to a
proportionate amount.

1
IN WITNESS OF WHICH I, _________ have signed my name on ________, declaring and
publishing this instrument as the Codicil to my Last Will.

SIGNED by the within named testator, in the joint presence of us both who at the request
and in the presence of the testator and that of each other hereto subscribed our names as
witnesses.

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Signature of Testator

WITNESS

1. Name: …………………………………………………………...
Address: ………………………………………………………...
Occupation: ……………………………………………………..

Signature: ………………………………………………………..

2. Name: ……………………………………………………………
Address: …………………………………………………………
Occupation: ……………………………………………………..

Signature: ………………………………………………………..