LAST WILL AND TESTAMENT OF

___________________________________

I.

I, ______________, residing at _________, ___________, being

of sound mind and in the contemplation of the certainty of death,

do hereby declare this instrument to be my last will and

testament.

II.

I hereby revoke all previous wills and codicils.

III.

I direct that the disposition of my remains be as follows:

_________________________________________________________________

IV.

I give all the rest and residue of my estate to my spouse,

_________________________________, should they survive me for 60

days. If my spouse, _________________________________, does not

survive me, I give all the rest and residue of my estate to

____________________. If neither _____________________________

nor ____________________, survives me, I give all the rest and

residue of my estate to my heirs as determined by the laws of the

State of ____________, relating to descent and distribution.

V.

I appoint __________________, to act as the executor of this

will, to serve without bond. Should __________________ be unable

or unwilling to serve, then I appoint ______________ to act as the

executor of this will.

I herewith affix my signature to this will on this

the ____________ day of ________________________________, 19___

at ________________________________________, in the presence of

the following witnesses, who witnessed and subscribed this will at

my request, and in my presence.

ATTESTATION CLAUSE

On the date above written, ______________, well known to us

declared to us, and in our presence, that this instrument,

consisting of _____ pages, is their last will and testament, and

______________, then signed this instrument in our presence, and

at ______________'s request we now sign this will as witnesses in

each other's presence. Further that ______________, appeared to us

to be of sound mind and lawful age, and under no undue influence.

Witness:

_______________________________________________________________

Address: ______________________________________________________

Witness:

_______________________________________________________________

Address: ______________________________________________________

Witness:

_______________________________________________________________

Address: ______________________________________________________

STATE OF ______________

COUNTY OF _____________

Before me, the undersigned authority authorized to take

acknowledgments and administer oaths, personally appeared:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

who after being having duly sworn or affirmed to tell the truth,

stated:

1. That ______________ declared this instrument to be their last

will and testament to the witnesses.

2. That ______________ signed this instrument in their presence.

3. That the witnesses signed as witnesses in the presence of

______________ and each other.

4. That ______________ is well known to the witnesses, and the

witnesses believe ______________ to be of lawful age, of sound

mind and under no undue influence or constraint.

______________________________________________________________

Officer

Title of Officer:__________________________________________

My Commission Expires: _________________________