SPECIFIC DIRECTIVE CODICIL TO THE
LAST WILL AND TESTAMENT
OF ________________________
WHEREAS, on ________________________, I, ________________________, residing and
domiciled at ________________________ in the City of ________________________, in the
County of ________________________ and in the State of ________________________
________________________, executed my last will and testament, and; WHEREAS, I made
various instructions and bequests, and, WHEREAS, I desire to add an additional provision to the
will; I NOW PUBLISH THIS CODICIL to my LAST WILL AND TESTAMENT.
My Last Will and Testament is to be amended to add the following provisions:
IN WITNESS WHEREOF, I have set my hand and seal on ________________________.
_____________________________________________
(TESTATOR/TESTATRIX SIGNATURE)
TESTATION CLAUSE
Subscribed by ________________________, Testator/Testatrix, in the presence of each of us, the
undersigned witnesses, being first duly sworn, and at the same time declared by the
Testator/Testatrix to us that this is the ________________________ Codicil to his/her LAST WILL
AND TESTAMENT, and we thereupon at his/her request, in his/her presence and in the presence of
each other sign our names as Witness hereto effective ________________________.
WITNESSES SIGNATURES AND INFORMATION:
_______________________________________________________________
(________________________)
________________________
________________________, ________________________ ________________________
_______________________________________________________________
(________________________)
________________________
________________________, ________________________ ________________________
_______________________________________________________________
(________________________)
________________________
________________________, ________________________ ________________________
SELF-PROVING AFFIDAVIT
STATE OF ________________________ )
) ss.
COUNTY OF ________________________ )
IN WITNESS WHEREOF, the undersigned authority personally appearing before me on this day
________________________, the Testator/Testatrix, and the Witnesses, whose names are shown in
the foregoing instrument in their respective capacities, and all of said individuals being first duly
sworn by me, said Testator/Testatrix declared to me and to the aforementioned Witnesses in my
presence that said instrument is the ________________________ Codicil to his/her LAST WILL
AND TESTAMENT and the s/he had willingly made and executed it as his/her free and voluntary
act and deed for the purposes therein expressed; and the said Witnesses each on his/her oath stated
to me in the presence and hearing of the said Testator/Testatrix that the said Testator/Testatrix had
declared to them that said instrument is the ________________________ Codicil to his/her LAST
WILL AND TESTAMENT, and that s/he executed the same as such and wanted each of them to
sign it as a Witness; and upon their oaths each Witness stated further that they did sign the same as
a Witnesses; and upon their oaths of each Witness stated further that they did sign the same as
Witnesses in the presence of the said Testator/Testatrix and at his/her request, and that said
Testator/Testatrix was at the time of the age of consent of 18 years of age or over and was of sound
mind.
Testator/Testatrix Signature:
Witness 1 Signature:
Witness 2 Signature:
Witness 3 Signature:
Subscribed and acknowledged before me by the said Testator/Testatrix, and subscribed and sworn
to before me by the aforementioned Witnesses, on ___________________________.
Notary Public Signature:
My Commission Expires:
NOTARY ACKNOWLEDGMENT
________________________ CODICIL TO THE
LAST WILL AND TESTAMENT
OF
________________________
I, ________________________, residing and domiciled in the City of
________________________, in the County of ________________________ and in the State of
________________________, hereby make, publish and declare this to be a Codicil to my LAST
WILL AND TESTAMENT dated ________________________.
My Last Will and Testament is to be amended to add the following provisions:
________________________
IN WITNESS WHEREOF, I ________________________, have to this
________________________ Codicil of my LAST WILL AND TESTATMENT, subscribed
my name as of _____________________________________.
____________________________________________________
TESTATOR/TESTATRIX SIGNATURE
Witness 1 Signature:
Witness 2 Signature:
Witness 3 Signature:
Subscribed and acknowledged before me by the said Testator/Testatrix, and subscribed and sworn
to before me by the aforementioned Witnesses.
Notary Public Signature:
My Commission Expires:
