I/We the undersigned,
the Testator, (Witness)
and
(Witness), the Testator and the witnesses, respectively,
whose names are signed to the attached or foregoing
instrument, being first duly sworn, declare to the
undersigned authority that said instrument is the
Testator's Last Will and Testament, dated
, and that the Testator willingly signed and
executed such instrument , or expressly directed another
to sign the same in the presence of the witnesses, as a
free and voluntary act for the purposes therein
expressed; that said witnesses, and each of them,
declared to the undersigned authority that such Will was
executed and acknowledged by the Testator as the
Testator's Last Will and Testament in their presence and
that they, in the Testator's presence, at the Testator's
request, and in the presence of each other, did
subscribe their names hereto as attesting witnesses on
the date of the date of such Last Will and Testament;
and that the Testator, at the time of the execution of
such instrument, was of full age and of sound mind and
that the witnesses were sixteen (16) years of age or
older and otherwise competent to be witnesses.
We,
and
, the witnesses, sign our names to this
instrument, being first duly sworn, and do hereby declare to the undersigned authority
that the Testator signs and executes this instrument as his/her
Last Will and Testament and
that he/she signs it willingly (or willingly directs another to sign for him/her), and that
each of us, in the presence and hearing of the Testator, hereby signs this
Will as witness to the Testator's signing, and that to the best of our knowledge the
Testator is eighteen (18) years of age or older, of sound mind and under no constraint
or undue influence.
| State
of |
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) |
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|
)ss |
| County
of |
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) |
Subscribed, sworn to and acknowledged before me by
, the Testator and subscribed and sworn to before me
by
and
, witnesses, this
day of
,
.
| (SEAL) |
(Signed) |
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(Official
Capacity of Officer) |