SETTLEMENT OF DEBTS

FROM INSURANCE CLAIM

As codicil and amendment to my will, dated ___________________, and witnessed by

______________________________, __________________________________, and ______________________________, I, ______________________________ declare the following:

Upon my death, my executor shall settle all of my outstanding debts and taxes with the funds collected from any and all life insurance policies which name me, my executor, or my estate as the beneficiaries.

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Signature Date

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Witnessed Date

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Witnessed Date

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Witnessed Date