CODICIL TO THE LAST WILL AND TESTAMENT OF
________
I, ________, (the "Testator") of ________, Alabama, declare this to be my codicil (my "Codicil") to my last will and testament being dated ________ (my "Last Will").
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B. My Last Will is hereby modified by deleting the following provision:
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C. My Last Will is hereby modified to include the following change:
The following portion of my Last Will is revoked:
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and is replaced with the following text:
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D. I hereby confirm and republish my Last Will dated ________ in all respects other than those mentioned here.
IN WITNESS WHEREOF, I have signed my name on this ______ day of the month of ___________________ of the year ___________, in the City of ________________, the State of Alabama, declaring and publishing this instrument as my Codicil to Last Will, in the presence of the undersigned witnesses, who witnessed and subscribed this Codicil to Last Will at my request, and in my presence.
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________, Testator
SIGNED AND DECLARED by ________ on this ______ day of the month of ___________________ of the year ___________ as and for the Testator's Codicil to Last Will, in the presence of us, who, at the Testator's request, in the Testator's presence, and in the presence of each other, have subscribed our names as witnesses on the date written above.
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Witness #1 Signature
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Witness #1 Printed Name
___________________________
Witness #1 Street Address
___________________________
Witness #1 City, State
___________________________
Witness #2 Signature
___________________________
Witness #2 Printed Name
___________________________
Witness #2 Street Address
___________________________
Witness #2 City, State
AFFIDAVIT
I, ________, the undersigned Testator, do hereby declare that I sign (or direct another to sign for me) and execute this instrument as my Codicil to Last Will, that I sign it willingly (or willingly direct another to sign it for me) in the presences of each of said witnesses, and that I execute it as my free and voluntary act for the purposes herein expressed.
______________________________________
________, Testator
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Witness #1 Signature
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Witness #2 Signature
STATE OF Alabama
COUNTY OF _______________________
Subscribed, sworn to, and acknowledged before me by ________, the Testator, and
subscribed and sworn to before me by ___________________________,
___________________________, and ___________________________, witnesses, this
_________ day of _____________________, 20_____.
(seal)
(signed)___________________________
___________________________
(Official capacity of officer)