The authorized person shall sign and attach to the will a certificate establishing that the requirements of sections 524.2-1002 to 524.2-1005 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. The certificate must be substantially in the following form:

CERTIFICATE

(Convention of October 26, 1973)

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, date and place of birth) in my

presence and that of the witnesses

4. (a) ...............(name, address, date and

place of birth)

(b) ...............(name, address, date and

place of birth)

has declared that the attached document is his/her will

and that ..he knows the contents thereof.

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/her signature previously affixed.

*(2) following a declaration of the testator stating

that the testator was unable to sign the will

for the following

reason.................................,

I have mentioned this declaration on the will,

*and the signature has been affixed

by.....................

(name and address)

7. (b) the witnesses and I have signed the will;

8. *(c) each page of the will has been signed

by ................ and numbered;

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;

11. *(f) the testator has requested me to include

the following

statement concerning the safekeeping of the will:

....................................................

12. ..............................PLACE OF EXECUTION

13. ..............................DATE

14. ..............................SIGNATURE

and, if necessary, SEAL........

*to be completed if appropriate

History: 1978 c 525 s 6; 1986 c 444