CODICIL 

WHEREAS, on __________, I, ____________, executed my last will 
and testament,  and; 

WHEREAS, I made various instructions and bequests, and,  

WHEREAS , I desire to revoke a bequest 

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

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

revoke and rescind that certain bequest to ______________________
__________________, and that  this bequest shall pass with the
residue of the estate. 

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: _________________________