(1) The authorized person shall attach to the will a certificate to be signed by him establishing that the requirements of this part 10 for valid execution of an international will have been fulfilled. The authorized person shall keep a copy of the certificate and deliver another to the testator.
(2) The certificate shall be substantially in the following form:
CERTIFICATE
1.
I, _______________ (name, address, and capacity), a person authorized to act in
connection with international wills,
2.
certify that on ______ (date) at ___________ (place)
3.
(testator)____________________________________________________
(name, address, and date and place of birth) in my presence and that of the
witnesses
4.
(a) _____________ (name, address, and date and place of birth)
(b) _____________ (name, address, and date and place of birth) has declared
that the attached document is his will and that he knows the contents thereof.
*(c) ______________ (social security number or any other individual-identifying
number established by law)
5.
I furthermore certify that:
6.
(a) In my presence and in that of the witnesses
(1) the testator has signed the will or has acknowledged his signature previously
affixed.
*(2) following a declaration of the testator stating that he was unable to sign his
will for the following reason _________________________, I have mentioned
this declaration on the will,
* and the signature has been affixed by ______________ (name and address)
(to be completed if testator unable to sign)
7.
(b) the witnesses and I have signed the will;
8.
*(c) each page of the will has been signed by _______________ and
numbered (to be completed if testator unable to sign);
9.
(d) I have satisfied myself as to the identity of the testator and of the witnesses
as designated above;
10.
(e) the witnesses met the conditions requisite to act as such according to
the law under which I am acting;
*(f) the intended place of deposit of safekeeping of the instrument pending the death of the testator is _________________.
11.
*(g) the testator has requested me to include the following statement
concerning the safekeeping of his will:
12.
PLACE OF EXECUTION
13.
DATE
14.
SIGNATURE
* to be completed if appropriate
Source: L. 89: Entire part added, p. 812, § 1, effective April 17.