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CODICIL TO LAST WILL AND TESTAMENT OF ________________________

I, ________________________ (the 'Testator') of ______________________, Virginia, declare this to be my codicil (my 'Codicil') to my last will and testament being dated the 11th day of December, 2024 (my 'Last Will').

  1. Clause __________ of my Last Will will be modified as follows:

    The beneficiary of __________ will be changed from "________________________" to "________________________ of __________, Virginia".

  2. I hereby confirm and republish my Last Will dated the 11th day of December, 2024 in all respects other than those mentioned here.

IN WITNESS WHEREOF, I have signed my name on this the ________ day of ________________, ________, at __________, Virginia, 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 the ________ day of ________________, ________ to be his Codicil to Last Will, in our presence, at __________, Virginia, who at his request, in his 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 Name (Please Print)
__________________________
Witness #1 Street Address
__________________________
Witness #1 City/State

__________________________
Witness #2 Signature
__________________________
Witness #2 Name (Please Print)
__________________________
Witness #2 Street Address
__________________________
Witness #2 City/State

__________________________
Witness #3 Signature
__________________________
Witness #3 Name (Please Print)
__________________________
Witness #3 Street Address
__________________________
Witness #3 City/State


AFFIDAVIT

STATE OF VIRGINIA

COUNTY/CITY OF _____________________________

Before me, the undersigned authority, on this day personally appeared ________________________, ____________________, ____________________ and ____________________, known to me to be the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument and, all of these persons being by me first duly sworn, ________________________, the Testator, declared to me and to the witnesses in my presence that the instrument is the Codicil to Last Will of the Testator and that he had willingly signed or directed another to sign the same for him, and executed it in the presence of said witnesses as his free and voluntary act for the purposes therein expressed; that said witnesses stated before me that the foregoing Codicil to Last Will was executed and acknowledged by the Testator as his Codicil to Last Will in the presence of said witnesses who, in his presence and at his request, and in the presence of each other, did subscribe their names thereto as attesting witnesses on the day of the date of said Codicil to Last Will, and that the Testator, at the time of the execution of said Codicil to Last Will, was over the age of eighteen years and of sound and disposing mind and memory.


_____________________________
Testator


____________________________
Witness #1


____________________________
Witness #2


____________________________
Witness #3

Subscribed, sworn and acknowledged before me by ________________________, the Testator, and subscribed and sworn before me by ____________________, ____________________ and ____________________, witnesses, this _____ day of ____________________, A.D. 20_______.


SIGNED _____________________________

______________________________________
(OFFICIAL CAPACITY OF OFFICER)



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