Colorado Revised Statutes Title 15. Probate, Trusts, and Fiduciaries § 15-11-1006. Certificate that requirements for an international will have been met

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 witnesses

4.

(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:

12.

PLACE OF EXECUTION

13.

DATE

14.

SIGNATURE

*

to be completed if appropriate