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 the following

individuals, share and share alike:

___________________________________________________________________

If none of my designated beneficiaries survives 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: ________________________