Section 15-11-1006 - Certificate that requirements for an international will have been met(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 witnesses4.(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:14. SIGNATURE * to be completed if appropriate
L. 89: Entire part added, p. 812, § 1, effective April 17.