The Florida Senate

STATE OF   

COUNTY OF   

I,    , declare to the officer taking my acknowledgment of this instrument, and to the subscribing witnesses, that I signed this instrument as my will.

Testator

We,    and   , have been sworn by the officer signing below, and declare to that officer on our oaths that the testator declared the instrument to be the testator’s will and signed it in our presence and that we each signed the instrument as a witness in the presence of the testator and of each other.

Witness

Witness

Acknowledged and subscribed before me by means of ☐ physical presence or ☐ online notarization by the testator,   (type or print testator’s name)  , who ☐ is personally known to me or ☐ has produced   (state type of identification—see s. 117.05(5)(b)2.)   as identification, and sworn to and subscribed before me by each of the following witnesses:   (type or print name of first witness)   who ☐ is personally known to me or ☐ has produced   (state type of identification—see s. 117.05(5)(b)2.)   as identification, by means of ☐ physical presence or ☐ online notarization; and   (type or print name of second witness)   who ☐ is personally known to me or ☐ has produced   (state type of identification—see s. 117.05(5)(b)2.)   as identification, by means of ☐ physical presence or ☐ online notarization. Subscribed by me in the presence of the testator and the subscribing witnesses, by the means specified herein, all on   (date)  .

  (Signature of Officer)  

  (Print, type, or stamp commissioned name and affix official seal)