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