005801\00950\109217745.v1-4/3/20
A codicil is a document your attorney can prepare to amend your will without re-
writing the entire document. State law governs wills, codicils and trusts. Further,
any gift you make may have tax consequences under state and federal law. You
should consult an attorney experienced in tax and estate planning in the state where
you live to prepare or amend a codicil or will. Deborah Hospital Foundation does
not provide legal or tax advice. This sample codicil is provided to give general
information about the form such a document may take and language that may be
used to make a gift to Deborah.
YOU SHOULD CONTACT YOUR LEGAL ADVISOR OR OTHER ATTORNEY TO PREPARE A
WILL OR CODICIL FOR YOU.
2
005801\00950\109217745.v1-4/3/20
I, Testator Name , a resident of the County of __________, and State of __________,
being of sound mind, memory and understanding, do make, publish and declare this to be a
Codicil to my Last Will and Testament dated Date of Last Will and Testament (my “Will”).
Changes or additions to the original will would be listed in the body of the codicil.
Each article, paragraph or section of the will to be revised must be identified. For
example:
FIRST: I hereby amend Article/Paragraph __________ of my Will by adding a new
Paragraph/subparagraph which shall read as follows:
“I give to DEBORAH HOSPITAL FOUNDATION, a qualified 501(c)(3) charitable
organization located in Browns Mills, New Jersey, the sum of $_______ to be
used for its general purposes, without further restriction as to use.”
or
“I give to DEBORAH HOSPITAL FOUNDATION, a qualified 501(c)(3) charitable
organization located in Browns Mills, New Jersey, _____% of the residue of my
estate to be used for its general purposes, without further restriction as to use.”
SECOND: In all other respects I do hereby ratify, confirm and approve my Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
, 2020.
___________________________________ (L.S.)
Testator Name
Signed, sealed, published and declared by the said Testator, Testator Name , as
and for a Codicil to his/her Last Will and Testament, in the presence of us, all being present at
the same time, who, at his/her request and in his/her sight and presence, and in the sight and
presence of each other, have hereunto subscribed our names as attesting witnesses.
3
005801\00950\109217745.v1-4/3/20
I, Testator Name , the Testator, sign my name to this instrument this ________ day of
____________________, 2020, and being duly sworn, do hereby declare to the undersigned
authority that I sign and execute this instrument as a Codicil to my Last Will and Testament and
that I sign it willingly (or willingly direct another to sign for me), that I execute it as my free and
voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of
sound mind, and under no constraint or undue influence.
____________________________________
Testator Name , Testator
We, _______________________ and ______________________, the witnesses, sign
our names to this instrument, and, being duly sworn, do hereby declare to the undersigned
authority that the Testator signs and executes this instrument as a Codicil to the Testator’s Last
Will and Testament and that the Testator signs it willingly (or willingly directs another to sign
for him/her), 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 :
: ss.
COUNTY OF :
Subscribed, sworn to and acknowledged before me by Testator Name , the Testator,
and subscribed and sworn to before me by and , witnesses,
this ________ day of ______________________, 2020.
____________________________________
Notary Public
