AB985,9,2424
1. The name and residential address of the remotely located individual is ....
AB985,9,2525
2. The name and [residential or business] address of the notary public is ....
AB985,10,3
13. The address within the state of Wisconsin where the remotely located
2individual was physically located at the time the remotely located individual signed
3the estate planning document is ....
AB985,10,64
4. The address within the state of Wisconsin where the notary public was
5physically located at the time the notary public witnessed the remotely located
6individual's signing of the estate planning document is ....
AB985,10,117
5. The remotely located individual and notary public were known to each other
8and to the supervising attorney. - OR - The remotely located individual and notary
9public were not known to each other and to the supervising attorney. The remotely
10located individual produced the following form of photo identification to confirm his
11or her identity:
AB985,10,1413
6. The following persons were in the same physical location as the remotely
14located individual during the signing:
AB985,10,1916
7. The remotely located individual declared that the remotely located
17individual is 18 years of age or older, that the document is the remotely located
18individual's [name of estate planning document], and that the document was being
19executed as the remotely located individual's voluntary act.
AB985,10,2320
8. The notary public and the supervising attorney were able to see the remotely
21located individual sign or another individual on behalf of the remotely located
22individual sign. The remotely located individual appeared to be 18 years of age or
23older and acting voluntarily.
AB985,10,2424
9. The audiovisual technology used for the signing process was ....
AB985,11,10
110. The estate planning document was not signed in counterpart. The following
2methods were used to forward the estate planning document to the notary public and
3to the supervising attorney after signing. - OR - The estate planning document was
4signed in counterpart. The following methods were used to forward each counterpart
5to the supervising attorney. [If applicable] - The supervising attorney physically
6compiled the signed paper counterparts into a single document containing the estate
7planning document, the signature of the remotely located individual, and the
8notarial act on [date] by [e.g., attaching page 7 from each counterpart signed by the
9notary public to the back of the estate planning document signed by the remotely
10located individual].
AB985,11,1211
11. The name, state bar number, and [business or residential] address of the
12supervising attorney is ....
AB985,11,1413
12. [Optional] Other information that the supervising attorney considers to be
14material is as follows: ....
AB985,11,1515
.... (signature of supervising attorney)
AB985,11,1716
Subscribed and sworn to before me on .... (date) by .... (name of supervising
17attorney).
AB985,11,1818
.... (signature of notarial officer)
AB985,11,2020
.... (Title of office)
AB985,11,2121
[My commission expires: ....]
AB985,11,25
22(6) If a supervising attorney is required to complete an affidavit in order to
23execute an estate planning document pursuant to another provision of law, the
24information required in that affidavit may be combined with the information
25required in the affidavit of compliance into a single affidavit.
AB985,12,3
1(7) For a notarial act performed under this section, the certificate of notarial
2act required under s. 140.15 may be in the following short form, if completed with the
3information required by s. 140.15 (1) and (2):
AB985,12,44
State of ....
AB985,12,55
County of ....
AB985,12,76
This record was virtually acknowledged before me pursuant to Wis. Stat. §
7140.147 on .... (date) by .... (name(s) of individual(s)).
AB985,12,88
.... (signature of notarial officer)
AB985,12,1010
.... (Title of office)
AB985,12,1111
[My commission expires: ....]
AB985,2
12Section
2. 154.03 (1) (e) of the statutes is created to read:
AB985,12,1313
154.03
(1) (e) Under the age of 18.
AB985,3
14Section 3
. 154.03 (3) of the statutes is created to read:
AB985,12,1715
154.03
(3) For purposes of this section, “presence” includes the simultaneous
16remote appearance by 2-way, real-time audiovisual communication technology if all
17of the following conditions are satisfied:
AB985,12,1918
(a) The signing is supervised by an attorney in good standing licensed by this
19state. The supervising attorney may serve as one of the remote witnesses.
AB985,12,2120
(b) The declarant attests to being physically located in this state during the
212-way, real-time audiovisual communication.
AB985,12,2322
(c) Each remote witness attests to being physically located in this state during
23the 2-way, real-time audiovisual communication.
AB985,13,224
(d) The declarant and each of the remote witnesses identify themselves. If the
25declarant and remote witnesses are not personally known to each other and to the
1supervising attorney, the declarant and each of the remote witnesses display photo
2identification.
AB985,13,63
(e) The declarant identifies anyone else present in the same physical location
4as the declarant and, if possible, the declarant makes a visual sweep of the
5declarant's physical surroundings so that the supervising attorney and each remote
6witness can confirm the presence of any other person.
AB985,13,107
(f) The declarant displays the declaration to health care professionals, confirms
8the total number of pages and the page number of the page on which the declarant's
9signature will be affixed, and declares to the remote witnesses and the supervising
10attorney all of the following:
AB985,13,1111
1. That the declarant is 18 years of age or older.
AB985,13,1212
2. That the document is a declaration to health care professionals.
AB985,13,1313
3. That the document is being executed as a voluntary act.
AB985,13,1714
(g) The declarant, or an individual 18 years of age or older at the express
15direction and in the physical presence of the declarant, dates and signs the
16declaration to health care professionals in a manner that allows each of the remote
17witnesses and the supervising attorney to see the execution.
AB985,13,2318
(h) The audiovisual communication technology used allows communication by
19which a person is able to see, hear, and communicate in an interactive way with
20another person in real time using electronic means, except that if the declarant, a
21remote witness, or the supervising attorney has an impairment that affects hearing,
22sight, or speech, assistive technology or learned skills may be substituted for audio
23or visual if it allows that person to actively participate in the signing in real time.
AB985,13,2524
(i) The declaration to health care professionals indicates that it is being
25executed pursuant to this subsection.
AB985,14,1
1(j) One of the following occurs:
AB985,14,152
1. The declarant, or another person at the direction of the declarant, personally
3delivers or transmits by U.S. mail or commercial courier service the entire signed
4original declaration to health care professionals to the supervising attorney within
5a reasonable time after execution. The supervising attorney then personally delivers
6or transmits by U.S. mail or commercial courier service the entire signed original
7declaration to health care professionals to the remote witnesses within a reasonable
8time. The first remote witness to receive the original declaration to health care
9professionals signs and dates the original declaration to health care professionals as
10a witness and forwards the entire signed original declaration to health care
11professionals by personal delivery or U.S. mail or commercial courier service within
12a reasonable time to the 2nd remote witness, who signs and dates it as a witness and
13forwards the entire signed original declaration to health care professionals by
14personal delivery or U.S. mail or commercial courier service within a reasonable time
15to the supervising attorney.
AB985,15,616
2. The declarant, or another person at the direction of the declarant, personally
17delivers or transmits by U.S. mail or commercial courier service the entire signed
18original declaration to health care professionals to the supervising attorney within
19a reasonable time after execution, and transmits by facsimile or electronic means a
20legible copy of the entire signed declaration to health care professionals directly to
21each remote witness within a reasonable time after execution. Each remote witness
22then signs the transmitted copy of the declaration to health care professionals as a
23witness and personally delivers or transmits by U.S. mail or commercial courier
24service the entire signed copy of the declaration to health care professionals to the
25supervising attorney within a reasonable time after witnessing. The signed original
1and signed copies together shall constitute one original document, unless the
2supervising attorney, within a reasonable time after receiving the signed original
3and signed copies, compiles the signed original and signed copies into one document
4by attaching the signature pages of each remote witness to the original signed by or
5on behalf of the declarant, in which case the compiled document shall constitute the
6original.
AB985,15,157
3. The declarant and each of the remote witnesses sign identical copies of the
8original. The declarant, or another person at the direction of the declarant, and each
9of the remote witnesses personally deliver or transmit by U.S. mail or commercial
10courier service the signed originals to the supervising attorney within a reasonable
11time after execution. All of the signed originals together shall constitute one original
12document, unless the supervising attorney, within a reasonable time after receiving
13all signed originals, compiles the originals into one document by attaching the
14signature pages of each remote witness to the original signed by or on behalf of the
15declarant, in which case the compiled document shall constitute the original.
AB985,15,1716
(k) The supervising attorney completes an affidavit of compliance that contains
17the following information:
AB985,15,1818
1. The name and residential address of the declarant.
AB985,15,1919
2. The name and residential or business address of each remote witness.
AB985,15,2120
3. The address within this state where the declarant was physically located at
21the time the declarant signed the declaration to health care professionals.
AB985,15,2422
4. The address within this state where each remote witness was physically
23located at the time the remote witness witnessed the declarant's execution of the
24declaration to health care professionals.
AB985,16,3
15. A statement that the declarant and remote witnesses were all known to each
2other and the supervising attorney or a description of the form of photo identification
3used to confirm the identity of the declarant and each remote witness.
AB985,16,74
6. Confirmation that the declarant declared that the declarant is 18 years of
5age or older, that the document is the declarant's declaration to health care
6professionals, and that the document was being executed as the declarant's
7voluntary act.
AB985,16,118
7. Confirmation that each of the remote witnesses and the supervising attorney
9were able to see the declarant, or an individual 18 years of age or older at the express
10direction and in the physical presence of the declarant, sign, and that the declarant
11appeared to be 18 years of age or older and acting voluntarily.
AB985,16,1212
8. A description of the audiovisual technology used for the signing process.
AB985,16,1613
9. If the declaration to health care professionals was not signed in counterpart,
14a description of the method used to forward the declaration to health care
15professionals to each remote witness for signing and to the supervising attorney after
16signing.
AB985,16,2217
10. If the declaration to health care professionals was signed in counterpart,
18a description of the method used to forward each counterpart to the supervising
19attorney and, if applicable, how and when the supervising attorney physically
20compiled the signed paper counterparts into a single document containing the
21declaration to health care professionals, the signature of the declarant, and the
22signatures of the remote witnesses.
AB985,16,2423
11. The name, state bar number, and business or residential address of the
24supervising attorney.
AB985,17,5
112. Any other information that the supervising attorney considers to be
2material with respect to the declarant's capacity to sign a valid declaration to health
3care professionals, the declarant's and witnesses' compliance with this section, or
4any other information that the supervising attorney deems relevant to the execution
5of the declaration to health care professionals.
AB985,17,76
(L) The affidavit of compliance is attached to the declaration to health care
7professionals.
AB985,17,98
(m) An affidavit of compliance described in this subsection shall be
9substantially in the following form:
AB985,17,1010
AFFIDAVIT OF COMPLIANCE
AB985,17,1111
State of ....
AB985,17,1212
County of ....
AB985,17,1313
The undersigned, being first duly sworn under oath, states as follows:
AB985,17,1714
This Affidavit of Compliance is executed pursuant to Wis. Stat. § 154.03 (3) to
15document the execution of the declaration to health care professionals of [name of
16declarant] via remote appearance by 2-way, real-time audiovisual communication
17technology on [date].
AB985,17,1818
1. The name and residential address of the declarant is ....
AB985,17,1919
2. The name and [residential or business] address of remote witness 1 is ....
AB985,17,2020
3. The name and [residential or business] address of remote witness 2 is ....
AB985,17,2321
4. The address within the state of Wisconsin where the declarant was
22physically located at the time the declarant signed the declaration to health care
23professionals is ....
AB985,18,3
15. The address within the state of Wisconsin where remote witness 1 was
2physically located at the time the remote witness witnessed the declarant's execution
3of the declaration to health care professionals is ....
AB985,18,64
6. The address within the state of Wisconsin where remote witness 2 was
5physically located at the time the remote witness witnessed the declarant's execution
6of the declaration to health care professionals is ....
AB985,18,107
7. The declarant and remote witnesses were all known to each other and to the
8supervising attorney. - OR - The declarant and remote witnesses were not all known
9to each other and to the supervising attorney. Each produced the following form of
10photo identification to confirm his or her identity:
AB985,18,1412
8. The declarant declared that the declarant is 18 years of age or older, that the
13document is the declarant's declaration to health care professionals, and that the
14document was being executed as the declarant's voluntary act.
AB985,18,1715
9. Each of the remote witnesses and the supervising attorney were able to see
16the declarant sign. The declarant appeared to be 18 years of age or older and acting
17voluntarily.
AB985,18,1818
10. The audiovisual technology used for the signing process was ....
AB985,19,419
11. The declaration to health care professionals was not signed in counterpart.
20The following methods were used to forward the declaration to health care
21professionals to each remote witness for signing and to the supervising attorney after
22signing. - OR - The declaration to health care professionals was signed in
23counterpart. The following methods were used to forward each counterpart to the
24supervising attorney. [If applicable] - The supervising attorney physically compiled
25the signed paper counterparts into a single document containing the declaration to
1health care professionals, the signature of the declarant, and the signatures of the
2remote witnesses on [date] by [e.g., attaching page 7 from each counterpart signed
3by a remote witness to the back of the declaration to health care professionals signed
4by the declarant].
AB985,19,65
12. The name, state bar number, and [business or residential] address of the
6supervising attorney is ....
AB985,19,87
13. [Optional] Other information that the supervising attorney considers to be
8material is as follows: ....
AB985,19,99
.... (signature of supervising attorney)
AB985,19,1110
Subscribed and sworn to before me on .... (date) by .... (name of supervising
11attorney).
AB985,19,1212
.... (signature of notarial officer)
AB985,19,1414
.... (Title of office)
AB985,19,1515
[My commission expires: ....]
