OMISSION OF PARTICULAR INDIVIDUAL

 

As codicil and amendment to my will, dated ___________________, and witnessed by

______________________________, __________________________________, and ______________________________, I, ______________________________ declare the following:

 

I am fully aware that __________________________________________ is my __________________________________ (Relationship) and that I have omitted _________ (him/her) from my will.  This is neither unintentional nor an oversight.

 

 

____________________________________                          _______________

Signature                                                                                    Date

 

____________________________________                          _______________

Witness                                                                                      Date

 

____________________________________                          _______________

Witness                                                                                      Date

 

___________________________________                            _______________

Witness                                                                                      Date