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STATE OF -----------)
COUNTY OF ----------)
This day personally appeared before the undersigned authority [three names], who, having been first duly sworn, did depose and say:
They are the same persons who subscribed their names as witnesses to the annexed Will [omitted] of [name of Testatrix], dated [date]; Testatrix signed and acknowledged the writing here annexed as and for her Will in their presence; at the time, Testatrix was of sound and disposing mind and memory and over the age of eighteen years; at the request of Testatrix, they signed their names to the writing in the presence of Testatrix and in the presence of each other, as attesting witnesses; and they are making this affidavit at the request of Testatrix, to be offered in evidence when the Will is presented for probate.
*** If Required By FederaL or State Law ***
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____