N.D. Cent. Code § 30.1-08.2-05
The authorized person shall attach to the will a certificate to be signed by the authorized person establishing that the requirements of this chapter 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
I, _______________ (name, address, and capacity), a person authorized to act in connection with international wills, certify that on ________________ (date) at
________________ (place) ____________________ (name, address, date and place of birth of testator) in my presence and that of the witnesses ____________________ (name, address, date and place of birth of first witness) and ________________ (name, address, date and place of birth of second witness) has declared that the attached document is the testator's will and that the testator knows the contents thereof.
I further certify that in my presence and in that of the witnesses the testator has signed the will or has acknowledged the testator's signature previously affixed or that following a declaration of the testator stating that the testator was unable to sign the will for the following reason ______________, I have mentioned this declaration on the will, and the signature has been affixed by _____________________ (name and address).
I further certify that the witnesses and I have signed the will; each page of the will has been signed by _______________ and numbered [to be completed if appropriate]; I have satisfied myself as to the identity of the testator and of the witnesses as designated above; the witnesses met the conditions requisite to act as such according to the law under which I am acting; the testator has requested me to include the following statement concerning the safekeeping of the testator's will [to be completed if appropriate]: ________________________________.
____________________ (Place of execution)
____________________ (Date)
_________________________________ (Signature)
N.D.C.C. § 30.1-08.2-05