SETTLEMENT OF BANKRUPTCY
DISCHARGED DEBTS
As codicil and amendment to
my will, dated ___________________, and witnessed by
______________________________,
__________________________________, and ______________________________, I,
______________________________ declare the following:
In addition to all
outstanding debts I accrued at the time of my death, my executor shall also pay
$___________________ to ________________________, for the fulfillment of a debt
incurred, but discharged in __________________________ bankruptcy court on
_____________________.
_____________________________________ _______________
Signature Date
_____________________________________ _______________
Witnessed Date
_____________________________________ _______________
Witnessed Date
_____________________________________ _______________
Witnessed Date