District of Columbia Code Division III. Decedents' Estates and Fiduciary Relations. § 20-324. Action on petition.

1.

Were you one of the witnesses who signed the attached written document which is dated ____________ and is said to be the last will and testament of __________ of the District of Columbia who is now dead? (Please initial appropriate box.)

____ Yes ____ No

2.

Did __________________ (the testator) sign the attached document while in your presence?

____ Yes ____ No

3.

Did __________________________ (the testator) say the attached document was to be a part

of his will?

____ Yes ____ No

4.

At the time he signed the attached document, did _______________________________(the testator)

seem to you to be of sound mind and aware of what he was doing?

____ Yes ____ No

5.

Did _________________ (the testator) ask you to sign the attached document as a witness?

____ Yes ____ No

6.

When you signed the attached document as a witness, were __________ (the testator)

and all of the other witnesses who signed the document present?

____ Yes ____ No

7.

Were you present when each of the other witnesses signed the attached document?

____ Yes ____ No

8.

Did ________________________ (the testator) ask the other people who signed the attached

document to do so as witnesses?

____ Yes ____ No

9.

Was _______________________ (the testator) present when each of the witnesses signed the

attached document?

____ Yes ____ No

10.

What is your date of birth? ____________________

11.

Do you know of any will or codicil of ____________________(the testator) other than the

attached document?

____ Yes ____ No