STATE OF __________________)
) ss.
____________________________)
(Judicial District, County or Borough)

I, ______________________________________________Devise and bequeath
(Stockholders printed name)
My Stock in the SELDOVIA NATIVE ASSOCIATION, Inc. to:
Print Number of
Name: Address: State, Zip Relationship Shares

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

DATED at _____________________this____ day of_______________20______
                        (location)                         (day)                 (month)            (year)
____________________________________
STOCKHOLDERS Signature
On This ______day of ________________, 20___, the above-named person,
________________________________Who is to us and each of us well and
(Stockholder's name)
personally know, in our presence, and in the presence of us, signed (his)(her)
Last Will and Testament, and we, at (his)(her) presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto,