Sample Codicil

I give, devise, and bequeath $ ___________ to the American Lung Association, 55 W. Wacker

Drive, Suite 1150, Chicago, IL 60601, for its charitable uses and purposes.

In all other respects I ratify and confirm all of the provisions of my said last Will and Testament

dated on the _________ day of ______________, 20__.

IN WITNESS WHEREOF, I sign, publish and declare this instrument to be a Codicil to my last

Will and Testament in the presence of the persons witnessing said Codicil at my request this

_____ day of ___________, 20__.

_________________________ residing at __________________________