Section 13.12.915 - International will; certificateThe 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 wills2. certify that on ________ (date) at ________ (place)3. (testator) ________ (name, address, date, and place of birth) in my presence and that of the witnesses4.(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: ______________________________________________________________
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14. SIGNATURE and, if necessary, SEAL * to be completed if appropriate.