NUNCUPATIVE WILL 

STATE OF __________________)

COUNTY OF _________________)

_______________, being first duly sworn to tell the truth,
states: 



That affiant resides at: ________________________________________

That on ______________________, _______________ died, and at that
time was ____ years of age.

That on ___________________, TESTATOR, being in contemplation of
imminent death  due to terminal diagnosis, and in the opinion of
the WITNESS possessing  testamentary capacity, at approximately
____________, made the following  dispositions of assets before
________________________ and ___________________________:

__________________________________________________________________

That the substance of the disposition was reduced to writing on 
_________________________ by _____________________________.


FURTHER AFFIANT SAYS NOT. 




___________________________________ 
_______________ 


Sworn to and subscribed before me on ___________________. 





_____________________________________ 
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