LAST WILL AND TESTAMENT

OF

_________________________

I, _________________________, of _________________________, _________________________, revoke my former Wills and Codicils and declare this to be my Last Will and Testament.

ARTICLE I

PAYMENT OF DEBTS AND EXPENSES

I direct that my just debts, funeral expenses, and expenses of last illness be paid as provided under the _________________________.

ARTICLE II

DISPOSITION OF PROPERTY

All of the property that I own at my death, or which shall become payable to my estate or my personal representatives, and any property that I have the power to dispose of under my Will shall be distributed to the Trustee of the _________________________ to be administered and distributed as provided under that Trust.

ARTICLE III

NOMINATION OF EXECUTOR

I nominate _________________________, of _________________________, _________________________, as the _______________________, without bond or security.

ARTICLE IV

NOMINATION OF GUARDIAN

Should it become necessary to appoint a guardian of the person of a minor child, I nominate _________________________, of _________________________, _________________________, to serve as the Guardian of my surviving children who are minors at the time of my death.

ARTICLE V

_______________________ POWERS

My _______________________, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone.

IN WITNESS WHEREOF, I have subscribed my name below, this _____ day of _________________, 19___.

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_________________________

We, the undersigned, hereby certify that the above instrument, which consists of _____________ pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by _________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names and addresses as witnesses on the date shown above.

Witness Signature: ________________________________________

Witness Name: _________________________

Witness Address: ___________________________________

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Witness Signature: ________________________________________

Witness Name: _________________________

Witness Address: ___________________________________

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Witness Signature: ________________________________________

Witness Name: _________________________

Witness Address: ___________________________________

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AFFIDAVIT

STATE OF __________________________

COUNTY OF _________________________

Before me, the undersigned, on this day personally appeared _________________________, _________________________, _________________________, known to me to be the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument. All of these persons were first duly sworn by me. _________________________, the Testator, declared to me and to the witnesses, in my presence, that the foregoing instrument is the Testator's Will and that the Testator willingly signed and executed such instrument (or expressly directed another person to sign the instrument for the Testator in the Testator's presence) in the presence of the witnesses, as the Testator's free and voluntary act for the purposes expressed in the instrument. Each of the witnesses declared in the presence and hearing of the Testator that the foregoing instrument was executed and acknowledged by the Testator as the Testator's Will in their presence and that they, in the Testator's presence, hearing and sight and at the Testator's request, and in the presence of each other, did subscribe their names to the instrument as attesting witnesses on the date of the instrument. The Testator, at the time of the execution of such instrument, was of full age, of sound mind, and the witnesses were of adult age and otherwise competent to be witnesses.

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_________________________, Testator

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_________________________, Witness

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_________________________, Witness

Subscribed, sworn to and acknowledged before me by _________________________, the Testator; and subscribed and sworn before me by _________________________, _________________________, witnesses, this ____ day of ____________________, 19____.

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Notary Public, or other officer authorized to take and

certify acknowledgements and administer oaths