CODICIL 

WHEREAS, on ___________________, I, ___________________, executed
my last will and testament,  and; 

WHEREAS, I revoked said last will and testament by _______________
__________________________________________________________; and,

WHEREAS, it is now my intention to ratify said will; 

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

I ratify and reaffirm said will and confirm that the will 
executed on ___________________ is my last will and testament. 

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: _________________________