L. Any other information that the supervising attorney considers to be material with respect to the testator's capacity to sign a valid will, the testator's and witnesses' compliance with this section, or any other information that the supervising attorney deems relevant to the execution of the will.
12. The affidavit of compliance is attached to the will.
13. An affidavit of compliance executed in compliance with this section shall constitute a self-proving affidavit executed in compliance with s. 853.04 (2).
14. An affidavit of compliance described in this paragraph shall be substantially in the following form:
AFFIDAVIT OF COMPLIANCE
State of ....
County of ....
The undersigned, being first duly sworn under oath, states as follows:
This Affidavit of Compliance is executed pursuant to Wis. Stat. § 853.03 (2) (c) to document the execution of the will of [name of testator] via remote appearance by 2-way, real-time audiovisual communication technology on [date].
1. The name and residential address of the testator is ....
2. The name and [residential or business] address of remote witness 1 is ....
3. The name and [residential or business] address of remote witness 2 is ....
4. The address within the state of Wisconsin where the testator was physically located at the time the testator signed the will is ....
5. The address within the state of Wisconsin where remote witness 1 was physically located at the time the remote witness witnessed the testator's execution of the will is ....
6. The address within the state of Wisconsin where remote witness 2 was physically located at the time the remote witness witnessed the testator's execution of the will is ....
7. The testator and remote witnesses were all known to each other and to the supervising attorney. - OR - The testator and remote witnesses were not all known to each other and to the supervising attorney. Each produced the following form of photo identification to confirm his or her identity:
....
8. The testator declared that the testator is 18 years of age or older, that the document is the testator's will, and that the document was being executed as the testator's free and voluntary act.
9. Each of the remote witnesses and the supervising attorney were able to see the testator, the testator with the assistance of another person 18 years of age or older with the testator's consent, or another person 18 years of age or older signing in the testator's name at the testator's direction and in the testator's physical presence, sign. The testator appeared to be 18 years of age or older and acting freely and voluntarily.
10. The audiovisual technology used for the signing process was ....
11. The will was not signed in counterpart. The following methods were used to forward the will to each remote witness for signing and to the supervising attorney after signing. - OR - The will was signed in counterpart. The following methods were used to forward each counterpart to the supervising attorney. [If applicable] - The supervising attorney physically compiled the signed paper counterparts into a single document containing the will, the signature of the testator, and the signatures of the remote witnesses on [date] by [e.g., attaching page 7 from each counterpart signed by a remote witness to the back of the will signed by the testator].
12. The name, state bar number, and [business or residential] address of the supervising attorney is ....
13. [Optional] Other information that the supervising attorney considers to be material is as follows: ....
.... (signature of supervising attorney)
Subscribed and sworn to before me on .... (date) by .... (name of supervising attorney).
.... (signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
