IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Deceased. Division PROOF OF CODICIL STATE OF FLORIDA COUNTY OF _______________ The undersigned duly sworn says that: 1. deceased: a. b. c. 2. cannot be found. have become incapacitated after the execution of the will. are unavailable so that their testimony cannot be taken within a reasonable time. [strike out inapplicable phrases] The undersigned: a. b. 3. is the personal representative nominated by the will. has no interest in the estate under the will or codicil. [strike out inapplicable phrase] The undersigned believes the writing exhibited to the undersigned to be the _____ codicil The attesting witnesses to the writing dated , , exhibited , to the undersigned as the _________ codicil to the last will of being to the last will of the decedent. Sworn to and subscribed before me on , . Affiant [choose one] (SEAL) [Print or Type Names Under All Signature Lines] Bar Form No. P-3.0330 � Florida Lawyers Support Services, Inc. January 1, 201 American LegalNet, Inc. www.FormsWorkFlow.com