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)
AB985,12,99 Stamp
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:
AB985,18,1111 ....
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)
AB985,19,1313 Stamp
AB985,19,1414 .... (Title of office)
AB985,19,1515 [My commission expires: ....]
AB985,4 16Section 4. 154.30 (8) (d) 2. of the statutes is amended to read:
AB985,19,2417 154.30 (8) (d) 2. Be signed and dated by the declarant, with the signature
18witnessed by 2 witnesses who each have attained age 18 and who are not related by
19blood, marriage, or adoption to the declarant, or acknowledged before a notary
20public. If the declarant is physically unable to sign an authorization for final
21disposition, the authorization shall be signed in the declarant's name by an
22individual 18 years of age or older at the declarant's express direction and in his or
23her physical presence; such a proxy signing shall take place or be acknowledged by
24the declarant in the presence of 2 witnesses or a notary public.
AB985,5 25Section 5 . 154.30 (8m) of the statutes is created to read:
AB985,20,4
1154.30 (8m) Remote execution. For purposes of sub. (8) (d) 2., “witnessed by”
2and “in the presence of” include the simultaneous remote appearance by 2-way,
3real-time audiovisual communication technology if all of the following conditions are
4satisfied:
AB985,20,65 (a) The signing is supervised by an attorney in good standing licensed by this
6state. The supervising attorney may serve as one of the remote witnesses.
AB985,20,87 (b) The declarant attests to being physically located in this state during the
82-way, real-time audiovisual communication.
AB985,20,109 (c) Each remote witness attests to being physically located in this state during
10the 2-way, real-time audiovisual communication.
AB985,20,1411 (d) The declarant and each of the remote witnesses identify themselves. If the
12declarant and remote witnesses are not personally known to each other and to the
13supervising attorney, the declarant and each of the remote witnesses display photo
14identification.
AB985,20,1815 (e) The declarant identifies anyone else present in the same physical location
16as the declarant and, if possible, the declarant makes a visual sweep of the
17declarant's physical surroundings so that the supervising attorney and each remote
18witness can confirm the presence of any other person.
AB985,20,2219 (f) The declarant displays the authorization for final disposition, confirms the
20total number of pages and the page number of the page on which the declarant's
21signature will be affixed, and declares to the remote witnesses and the supervising
22attorney all of the following:
AB985,20,2323 1. That the declarant is 18 years of age or older.
AB985,20,2424 2. That the document is an authorization for final disposition.
AB985,20,2525 3. That the document is being executed as a voluntary act.
AB985,21,4
1(g) The declarant, or an individual 18 years of age or older at the express
2direction and in the physical presence of the declarant, dates and signs the
3authorization for final disposition in a manner that allows each of the remote
4witnesses and the supervising attorney to see the execution.
AB985,21,105 (h) The audiovisual communication technology used allows communication by
6which a person is able to see, hear, and communicate in an interactive way with
7another person in real time using electronic means, except that if the declarant, a
8remote witness, or the supervising attorney has an impairment that affects hearing,
9sight, or speech, assistive technology or learned skills may be substituted for audio
10or visual if it allows that person to actively participate in the signing in real time.
AB985,21,1211 (i) The authorization for final disposition indicates that it is being executed
12pursuant to this subsection.
AB985,21,1313 (j) One of the following occurs:
AB985,22,214 1. The declarant, or another person at the direction of the declarant, personally
15delivers or transmits by U.S. mail or commercial courier service the entire signed
16original authorization for final disposition to the supervising attorney within a
17reasonable time after execution. The supervising attorney then personally delivers
18or transmits by U.S. mail or commercial courier service the entire signed original
19authorization for final disposition to the remote witnesses within a reasonable time.
20The first remote witness to receive the original authorization for final disposition
21signs and dates the original authorization for final disposition as a witness and
22forwards the entire signed original authorization for final disposition by personal
23delivery or U.S. mail or commercial courier service within a reasonable time to the
242nd remote witness, who signs and dates it as a witness and forwards the entire

1signed original authorization for final disposition by personal delivery or U.S. mail
2or commercial courier service within a reasonable time to the supervising attorney.
AB985,22,183 2. The declarant, or another person at the direction of the declarant, personally
4delivers or transmits by U.S. mail or commercial courier service the entire signed
5original authorization for final disposition to the supervising attorney within a
6reasonable time after execution, and transmits by facsimile or electronic means a
7legible copy of the entire signed authorization for final disposition directly to each
8remote witness within a reasonable time after execution. Each remote witness shall
9then sign the transmitted copy of the authorization for final disposition as a witness
10and personally deliver or transmit by U.S. mail or commercial courier service the
11entire signed copy of the authorization for final disposition to the supervising
12attorney within a reasonable time after witnessing. The signed original and signed
13copies together shall constitute one original document, unless the supervising
14attorney, within a reasonable time after receiving the signed original and signed
15copies, compiles the signed original and signed copies into one document by
16attaching the signature pages of each remote witness to the original signed by or on
17behalf of the declarant, in which case the compiled document shall constitute the
18original.
AB985,23,219 3. The declarant and each of the remote witnesses sign identical copies of the
20original. The declarant, or another person at the direction of the declarant, and each
21of the remote witnesses personally deliver or transmit by U.S. mail or commercial
22courier service the signed originals to the supervising attorney within a reasonable
23time after execution. All of the signed originals together shall constitute one original
24document unless the supervising attorney, within a reasonable time after receiving
25all signed originals, compiles the originals into one document by attaching the

1signature pages of each remote witness to the original signed by the declarant, in
2which case the compiled document shall constitute the original.
AB985,23,43 (k) The supervising attorney completes an affidavit of compliance that contains
4the following information:
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