Last Will and Testament of *
  
I, * , whose address is * , declare that this is my Last Will and Testament and I revoke all previous wills.
  
I am married to * .

I have no children or grandchildren living.

I make the following specific gifts: *
  

I give all the rest of my property, whether real or personal, wherever located, to * , who is my * ,
or if not surviving to * , who is my * .
  
All beneficiaries named in this will must survive me by thirty (30) days to receive any gift under
this will. If any beneficiary and I should die simultaneously, I shall be conclusively presumed to
have survived that beneficiary for purposes of this will.
  
I appoint * , who is my * , whose address is * , as Executor, to serve without bond. If not surviving or otherwise unable to serve, I appoint * , who is my * , of * , as Alternate Executor, also to serve without bond.
  
In addition to any powers, authority, and discretion granted by law, I grant such Executor or
Alternate Executor any and all powers to perform any acts, in his or her sole discretion and
without court approval, for the management  and distribution of my estate, including independent 
administration of my estate.
  
I also declare that, pursuant to the Uniform Anatomical Gift Act, I donate any of my body parts
and/or organs to any medical institution willing to accept and use them, and I direct my executor
to carry out such donation.

Funeral arrangements have been made with the *, of *, for burial at *, located in *. I direct my
Executor to carry out such arrangements.

I publish and sign this Last Will and Testament, consisting of *  typewritten pages, on * , 20 * ,
and declare that I do so freely, for the purposes expressed, under no constraint or undue
influence, and that I am of sound mind and of legal age.
  
*  
Signature of Testator
*  
Printed Name of Testator
  

We, the undersigned, being first sworn on oath and under penalty of perjury, state that:

On * , 20* , in the presence of all of us, the above-named Testator published and signed this
Last Will and Testament, and then at Testator's request, and in Testator's presence, and in each
other's presence, we all signed below as witnesses, and we declare, under penalty of perjury, that, 
to the best of our knowledge, the Testator signed this instrument freely, under no constraint or
undue influence, and is of sound mind and legal age.
  
*  
Signature of Witness #1
*
Printed Name of Witness #1
*
Address of Witness #1
  
*
Signature of Witness #2
*
Printed Name of Witness #2
*
Address of Witness #2
  
*
Signature of Witness #3
*
Printed Name of Witness #3
*
Address of Witness #3							
  
Notary Acknowledgment

State of *									
County of *

On * , 20 *,  * , the Testator and * , * , and  * , the witnesses, personally came before me and, being duly sworn, did state that they are the persons described in the above document and that they signed the above document in my presence as a free and voluntary act for the purposes stated.

*
Signature of Notary Public

Notary Public, In and for the County of *
State of *

My commission expires: *                                                   Notary Seal *