Sec. 13.12.915. - International will; certificate. - Alaska Statutes

The authorized person shall attach to the international will a certificate to be signed by the authorized person establishing that the requirements of AS 13.12.912 - 13.12.921 for valid execution of an international will have been complied with. The authorized person shall keep a copy of the certificate and deliver another to the testator. The certificate shall 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 the testator's will and that the testator

knows the contents of the will;

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 the

testator's signature previously affixed.

* (2) following a declaration of the testator stating that the

testator was unable to sign the testator's 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

witnesses 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 testator's will:

________________________________________________________________

________________________________________________________________

12. PLACE OF EXECUTION

13. DATE

14. SIGNATURE and, if necessary, SEAL

* to be completed if appropriate.