I/We the undersigned,                                             the Testator, (Witness)                                         and                                      (Witness), the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, declare to the undersigned authority that said instrument is the Testator's Last Will and Testament, dated                                                            , and that the Testator willingly signed and executed such instrument , or expressly directed another to sign the same in the presence of the witnesses, as a free and voluntary act for the purposes therein expressed; that said witnesses, and each of them, declared to the undersigned authority that such Will was executed and acknowledged by the Testator as the Testator's Last Will and Testament in their presence and that they, in the Testator's presence, at the Testator's request, and in the presence of each other, did subscribe their names hereto as attesting witnesses on the date of the date of such Last Will and Testament; and that the Testator, at the time of the execution of such instrument, was of full age and of sound mind and that the witnesses were sixteen (16) years of age or older and otherwise competent to be witnesses. 

     We,                                             and                                            , the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Testator signs and executes this instrument as his/her Last Will and Testament and that he/she signs it willingly (or willingly directs another to sign for him/her), and that each of us, in the presence and hearing of the Testator, hereby signs this Will as witness to the Testator's signing, and that to the best of our knowledge the Testator is eighteen (18) years of age or older, of sound mind and under no constraint or undue influence.

     Subscribed, sworn to and acknowledged before me by                                      , the Testator and subscribed and sworn to before me by                                       and                                       , witnesses, this             day of                             ,             .