Last Will and Testament

Name of Testator: Address: Date:

1. Declaration

2. Appointment of Executor

Name of Executor: Address of Executor:

3. Beneficiaries

Name of Beneficiary: Relationship: Gift/Bequest: Name of Beneficiary: Relationship: Gift/Bequest:

4. Guardian for Minor Children (if applicable)

Name of Guardian: Address of Guardian:

5. Other Instructions

6. Signature

Signature of Testator: Date:

Witnesses

Name of Witness 1: Signature: Name of Witness 2: Signature: