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: ________________________