STATE OF NORTH CAROLINA County Name Of Decedent File No. IN THE MATTER OF THE ESTATE OF: In The General Court Of Justice Superior Court Division Before The Clerk Date Of Paper-Writing AFFIDAVIT OF SUBSCRIBING WITNESSES FOR PROBATE OF WILL CODICIL TO WILL G.S. 28A-2A-6, 28A-2A-8, and 28A-2A-16 I, the undersigned subscribing witness, being first duly sworn, say that: 1. I signed the paper-writing referred to above as a subscribing witness; 2. The decedent, in my presence, signed the paper-writing, or acknowledged his/her signature thereto and at such time declared the paper-writing to be the decedent's instrument; 3. At the request and in the presence of the decedent, I signed the paper-writing as an attesting witness; and 4. In my opinion the decedent was, at the time the paper-writing was executed or at the time the execution was acknowledged, of sound mind and disposing memory, of full age to execute a will, and was not under any restraint to my knowledge, information or belief; 5. I am am not a beneficiary or the spouse of a beneficiary under the will. Signature Of Subscribing Witness Name Of Subscribing Witness (Type Or Print) Signature Of Subscribing Witness Name Of Subscribing Witness (Type Or Print) SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Deputy CSC Clerk Of Superior Court Assistant CSC Date My Commission Expires Notary Date SWORN AND SUBSCRIBED TO BEFORE ME Signature Of Person Authorized To Administer Oaths Deputy CSC Assistant CSC SEAL Clerk Of Superior Court Date My Commission Expires Notary County And State (Or Country) Where Oath Administered SEAL County And State (Or Country) Where Oath Administered AOC-E-300, Rev. 8/12 © 2012 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com