72-2-905. Certificate. The authorized person shall attach to the will a certificate to be signed by him establishing that the requirements of this part 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)

     I, ______________ (name, address, and capacity), a person authorized to act in connection with international wills, certify that on _________ (date) at ____________ (place) (testator) _________________ (name, address, date, and place of birth) in my presence and that of the witnesses
     (a) ______________ (name, address, date, and place of birth)
     (b) ______________ (name, address, date, and place of birth) has declared that the attached document is his will and that he knows the contents thereof.
     I furthermore certify that:
     (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);
     (b) the witnesses and I have signed the will;
     *(c) each page of the will has been signed by _____________ and numbered;
     (d) I have satisfied myself as to the identity of the testator and of the witnesses as designated above;
     (e) the witnesses met the conditions requisite to act as such according to the law under which I am acting;
     *(f) the testator has requested me to include the following statement concerning the safekeeping of his will:
     
     PLACE OF EXECUTION
     DATE
     SIGNATURE and, if necessary, SEAL
     

     
     * to be completed if appropriate

     History: En. Sec. 5, Ch. 62, L. 1991.