WHEREAS, on __________, I, ____________, executed my last will

and testament, and;

WHEREAS, I made various instructions and bequests, and,

WHEREAS , in my will I made a division of my estate in per

centages, and I desire to alter the same,

I NOW PUBLISH THIS CODICIL to my last will and testament of

__________:

I reaffirm all parts and exhibits of said will, except that, I:

substitute the following allocations for those in the will being

superseded:

_________________________________________________________

I direct that the executors of my estate deliver acquittances of

the debt.

Dated: _______________________

_______________________________

____________, TESTATOR

I herewith affix my signature to this codicil on this

the ____________ day of ________________________________, 19___

at ________________________________________, in the presence of

the following witnesses, who witnessed and subscribed this

codicil 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 a codicil to their last will and

testament, and ____________, then signed this instrument in

our presence, and at ____________'s request we now sign this

codicil 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 a

codicil to 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: _________________________