As codicil and amendment to my will, dated ____________________, and witnessed by ______________________________, __________________________________, and ______________________________, I, ______________________________ declare the following:

I give to _________________________________________________________ the promissory note payable to me, dated _________________________, 19___, payable from __________________________________________________ on a principal of

$ ______________, with an interest rate of _______ %. All right to this note is granted solely to him/her.

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Signature Date

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Witness Date

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Witness Date

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Witness Date