International will; certificate.

The authorized person shall attach to the will a certificate to be signed by him establishing that the requirements of Sections 45-2-1101 through 45-2-1110 NMSA 1978 [45-2-1001 to 45-2-1010 NMSA 1978] 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 1. I, ________________________ (name, address, and capacity), a person authorized to act in connection with international wills, 2. certify that on __________________ (date) at __________________ (place) 3. (testator) ____ (name, address, date and place of birth) in my presence and that of the witnesses 4. (a) __________________ (name, address, date and place of birth) (b) __________________ (name, address, date and place of birth) has declared that the attached document is his will and that he knows the contents thereof. 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 his signature previously affixed; *(2) following a declaration of the testator stating that he was unable to sign his 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 such 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 his will: ________________________________________________________________ ________ 12. PLACE OF EXECUTION 13. DATE 14. SIGNATURE and, if necessary, SEAL *to be completed if appropriate.