I,                 , of the City of                 , County of                 , and State of                 , declare this to be my Last Will and hereby revoke all of my prior wills and codicils.

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1. I direct that my testamentary estate be disposed of in accordance with the Uniform Statutory Will Act, as in effect on the date of execution of this will.

2. I appoint                 as personal representative of my estate under this will. If a trust becomes applicable under the provision of the Act, I appoint                 as trustee hereunder. If either of them does not serve, or at any time ceases to serve, in either capacity, I appoint                 to serve in the vacant capacity or capacities. I appoint                 as guardian and conservator of my minor children. I,                 , the testator, sign my name to this instrument this                             day of                 , 19         , and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and that I (sign it willingly) (willingly direct another to sign for me) (cross out the one of these two alternatives that is inapplicable), that I execute one of these two alternatives that is inapplicable [sic], that I execute it as my free and voluntary act for the purpose therein expressed, and that I am 18 years of age or older, of sound mind, and under no constraint or undue influence.

                                     Testator

We,                 and                 the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the testator signs and executes this instrument as (his) (her) Last Will and that (he) (she) (signs it willingly) (willingly directs another to sign) (her) (him) (cross out the inapplicable word or phrase in each of these instances), and that each of us, in the presence and hearing of the testator, hereby signs this will as witness to the testator’s signing, and that to the best of our knowledge the testator is 18 years of age or older, of sound mind, and under no constraint or undue influence.

                                     Witness                                     Witness State of                                     County of                                     Subscribed, sworn to and acknowledged before me by                 , the testator, and subscribed and sworn to before me by                 and                 , witnesses, this                 day of                 , 19         .

(Seal) (Signed)                                                                                                         (official capacity of officer)