Codicil to the Last Will and Testament of
, a resident of
County, State of
declare that this is the codicil to my last will and testament, which is dated
I add or change said last will in the following manner:
Otherwise, I hereby confirm and republish my will dated,
, in all respects other than those herein mentioned.
I subscribe my name to this codicil this
, in the presence of
witnesses, who subscribe their names here in my presence.
On the date above written,
, known by us to be a person whose signature appears at the end of this codicil,
declared to us,
, the undersigned, that the foregoing instrument, consisting, of
page/s was the codicil
the will dated,
, who then signed the codicil in our presence, and now in the presence of each other, we sign our
names as witnesses.