I, State the name of the person revoking the wills, herewith revoke all previous wills and codicils.

Dated: _______________________

_________________________________________________

State the name of the person revoking the wills

We, the undersigned, witnessed the execution of this document by State the name of the person revoking the wills, and State the name of the person revoking the wills expressed to us that this document expressed their desires.

____________________________________ Dated: ________________

___________________________________ Dated: _________________