FIRST CODICIL TO THE
LAST WILL AND TESTAMENT 
OF
                                                                                       
(NAME OF PERSON)

     I,                                                       (name) of                                      (City),                        (State), do make, publish and declare this FIRST CODICIL to my Last Will and Testament dated                      (month),           (day),            (year).

I.

     I hereby revoke ARTICLE               of said Will and substitute the following in lieu thereof:

ARTICLE

     Further, I wish to add the following ARTICLE              in addition to the existing Articles:

ARTICLE             

II.

     In all other respects I hereby ratify and confirm the provisions of my Last Will and Testament dated                         ,              .

     I subscribed this my FIRST CODICIL to my Last Will and Testament on this             day of                                   ,              .

ATTESTATION CLAUSE

     We, the undersigned, certify that the foregoing instrument was, on the date thereof, signed and declared by                                            as                                             Codicil to Last Will in the presence of us, who in                                            's presence and in presence of each other have, at                                            's request, hereunto signed our names as witnesses of the execution thereof this                day of                                                   ; and we hereby certify that we believe said                                             to be of sound mind and memory.

SELF-PROVED WILL

     Each of the undersigned attesting witnesses to the Codicil to Will of,                                             dated _____________, _______ of which this affidavit is a part, first having been sworn on oath states that said testator stated to us that the above and foregoing instrument was                                              's Codicil to Last Will and requested each of us to witness                                           's signing of said Codicil to Will,  that each of us was present and saw the said testator sign said Codicil to Will in the presence of each of us, that said Codicil to Will was attested by each of us in the presence of the said testator and each of other and that each of us  believed said testator to be of sound mind and memory at the time of signed said Codicil to Will.

     We,                                             and                                            , the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Testator signs and executes this instrument as his/her Codicil to Last Will and that he/she signs it willingly (or willingly directs another to sign for him/her), and that each of us, in the presence and hearing of the Testator, hereby signs this Codicil to Last Will as witness to the Testator's signing, and that to the best of our knowledge the Testator is eighteen (18) years of age or older, of sound mind and under no constraint or undue influence.

     Subscribed, sworn to and acknowledged before me by                                      , the Testator and subscribed and sworn to before me by                                       and                                       , witnesses, this             day of                             ,             .