                                 CODE OF VIRGINIA

CERTIFICATE (§ 64.2-437)

The authorized person shall attach to the will a certificate to be signed by him
establishing that the requirements of this article 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)
		I,&#8230;&#8230;&#8230;&#8230;&#8230;.… (name, address and capacity), a
person authorized  to act in connection with international wills Certify that
on&#8230;&#8230;&#8230;&#8230;..…(date)&#8230;&#8230;&#8230;&#8230;… (place)
(testator)&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;… (name,
address, date and place of  birth)in my presence and that of the witnesses
(a)&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..… (name, address,
date and place of  birth)
(b)&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..… (name, address,
date and place of  birth) has declared that the attached document is his will
and that he knows  the contents thereof.
		I furthermore certify that:

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
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026; I have
   mentioned this declaration  on the will *and the signature has been affixed by
   (name and address)

b. the witnesses and I have signed the will; *(c) each page of the will has been
signed by &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026; and
numbered;

d. I have satisfied myself as to the identity of the testator and of  the
witnesses as designated above;

e. the witnesses met the conditions requisite to act as such  according to the
law under which I am acting;

f. the testator has requested me to include the following statement
			concerning the safekeeping of his will:
			PLACE OF EXECUTION DATE SIGNATURE and, if necessary, SEAL.
			* to be completed if appropriate

HISTORY: 1995, c. 443, § 64.1-96.6; 2012, c. 614.