Sample Codicil Form (Page 2 of 2) in pdf

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.

______________________________________________________________

Notary

My Commission Expires: _________________________

Codicil Review List

This is provided to inform you about this type of document and assist you in its

preparation.

This is a standard codicil form in which you can enter the changes you wish made to your

will. More sample codicil forms are available on-line for your review and education.

Please always be advised and in collaboration with your lawyer or financial planner in

your decisions such as adding a codicil.

Make multiple copies. Be sure to get three witnesses and a notary to vouch for the

signatures. Keep a copy with your last will and testament in all places you have that

placed.

Sample Codicil Form Page 2