DELAYED BEQUEST As codicil and amendment to my will, dated ___________________, and witnessed by ______________________________, __________________________________, and ______________________________, I, ______________________________ declare the following: I direct my executor to pay to my _____________________________ (Relationship), ___________________________________ (Name), the sum of $ ________________, _______ (Number) ___________ (Months, Years) after I die. ______________________________________ ____________________ Signature Date ______________________________________ ____________________ Witness Date ______________________________________ ____________________ Witness Date ______________________________________ ____________________ Witness Date