Do not just fill in and sign this form. 
To be legally valid, your will must be printed out (using 	this eForm) or typed, eliminating all items that don’t apply to you. You cannot just fill in the blanks of this form and try to use the completed form as your will.

Will Codicil
First Codicil to the Will of 	

I, 	 , a resident of 		 [county], State of 	 , declare this to be the first codicil to my will dated 	 , 	 .
FIRST: I revoke the provision of Clause 	 of my will that provided:
[include the exact will language you wish to revoke]
						
SECOND: I add the following provision to Clause 	 of my will:
[add whatever is desired]
						
THIRD: In all other respects I confirm and republish my will dated 	 , 	.
Dated: 	 , 	  .
Signature
I subscribe my name to this codicil this  	 day of 	 , 	 , at 	 [county], State of 	 .
I declare that it is my will, that I sign it willingly, that I execute it as my free and voluntary act for the purposes expressed, and that I am of the age of majority or otherwise legally empowered to make a codicil and under no constraint or undue influence.
Signature: 	
Witnesses
On this	 day of 	,	 , 	 [codicil maker’s name] declared to us, the undersigned, that this instrument was a codicil to      [  ] his      [  ] her    will and requested us to act as witnesses to it. The testator signed this codicil in our presence, all of us being present at the same time. We now, at the testator’s request, in the testator’s presence and in the presence of each other, subscribe our names as witnesses and declare we understand this to be the testator’s codicil and that to the best of our knowledge the testator is of the age of majority, or is otherwise legally empowered to make a codicil, and appears to be of sound mind and is under no constraint or undue influence.
We declare under penalty of perjury that the foregoing is true and correct, this 	 day of	 , 	 , at 	 [county], State of 	.
Witness 1
Signature: 	
Typed or printed name: 	
Residing at: 	
City, state, zip: 	
Witness 2
Signature: 	
Typed or printed name: 	
Residing at: 	
City, state, zip: