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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:
(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
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
14. SIGNATURE and, if necessary, SEAL
* to be completed if appropriate.
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