First Witness First Witness Signature (date) First Witness Name First Witness Address First Witness City, State and Zip Code Second Witness Second Witness Signature (date) Second Witness Name Second Witness Address Second Witness City, State and Zip Code Third Witness Third Witness Signature (date) Third Witness Name Third Witness Address Third Witness City, State and Zip Code STATE OF CITY OF We, , , , the witnesses, and , the Testator, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned officer that the Testator, in the presence of witnesses, signed the instrument as his Codicil to Last Will and Testament and that he signed voluntarily and that each of the witnesses in the presence of the Testator and in the presence of each other signed the Codicil as a witness, and that to the best of the knowledge of each witness, the Testator was, at the time, 18 or more years of age, of sound mind and under no constraint or undue influence..
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