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").

A. My Last Will is hereby amended to include the following additional provision:

-- ________

B. My Last Will is hereby modified by deleting the following provision:

-- ________

C. My Last Will is hereby modified to include the following change:

-- The following portion of my Last Will is revoked:

________

and is replaced with the following text:

________

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.

______________________________________
________, Testator

SIGNED AND DECLARED by ________ on this ______ day of the month of ___________________ of the year ___________ to be their Codicil to Last Will, in our presence in the City of ___________________, the State of Alabama, who at their request, in their presence and in the presence of each other, all being present at the same time, have signed our names as witnesses.

___________________________
Witness #1 Signature

___________________________
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

We, the undersigned witnesses, do hereby declare in the presence of the aforesaid Testator that the Testator signed (or directed another to sign for them and said person signed for them) and executed this instrument as their Codicil to Last Will in the presence of each of us, that they signed it willingly (or willingly directed another to sign it for her), that each of us hereby signs this Codicil to Last Will as witness in the presence of the Testator, and that to the best of our knowledge, the Testator is eighteen (18) years of age or over, of sound mine, and under no constraint or undo influence.

______________________________________
Witness #1 Signature

______________________________________
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)