3. The address within the state of Wisconsin where the remotely located individual was physically located at the time the remotely located individual signed the estate planning document is ....
4. The address within the state of Wisconsin where the notary public was physically located at the time the notary public witnessed the remotely located individual’s signing of the estate planning document is ....
5. The remotely located individual and notary public were known to each other and to the supervising attorney. - OR - The remotely located individual and notary public were not known to each other and to the supervising attorney. The remotely located individual produced the following form of photo identification to confirm his or her identity:
....
6. The following persons were in the same physical location as the remotely located individual during the signing:
....
7. The remotely located individual declared that the remotely located individual is 18 years of age or older, that the document is the remotely located individual’s [name of estate planning document], and that the document was being executed as the remotely located individual’s voluntary act.
8. The notary public and the supervising attorney were able to see the remotely located individual sign or another individual on behalf of the remotely located individual sign. The remotely located individual appeared to be 18 years of age or older and acting voluntarily.
9. The audiovisual technology used for the signing process was ....
10. The estate planning document was not signed in counterpart. The following methods were used to forward the estate planning document to the notary public and to the supervising attorney after signing. - OR - The estate planning document 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 estate planning document, the signature of the remotely located individual, and the notarial act on [date] by [e.g., attaching page 7 from each counterpart signed by the notary public to the back of the estate planning document signed by the remotely located individual].
11. The name, state bar number, and [business or residential] address of the supervising attorney is ....
12. [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: ....]
140.147(6)(6) If a supervising attorney is required to complete an affidavit in order to execute an estate planning document pursuant to another provision of law, the information required in that affidavit may be combined with the information required in the affidavit of compliance into a single affidavit. 140.147(7)(7) For a notarial act performed under this section, the certificate of notarial act required under s. 140.15 may be in the following short form, if completed with the information required by s. 140.15 (1) and (2): State of ....
County of ....
This record was virtually acknowledged before me pursuant to Wis. Stat. § 140.147 on .... (date) by .... (name(s) of individual(s)). .... (signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
140.147 HistoryHistory: 2023 a. 130. 140.15140.15 Certificate of notarial act. 140.15(1)(1) A notarial act must be evidenced by a certificate. The certificate must satisfy all of the following: 140.15(1)(a)(a) Be executed contemporaneously with the performance of the notarial act. 140.15(1)(b)(b) Be signed and dated by the notarial officer and, if the notarial officer is a notary public, be signed in the same manner as on file with the department. 140.15(1)(c)(c) Identify the jurisdiction in which the notarial act is performed. 140.15(1)(d)(d) Contain the title of office of the notarial officer. 140.15(1)(e)(e) If the notarial officer is a notary public, indicate the date of expiration, if any, of the officer’s commission. 140.15(2)(2) If a notarial act regarding a tangible record is performed by a notary public, an official stamp must be affixed to or embossed on the certificate. If a notarial act is performed regarding a tangible record by a notarial officer other than a notary public and the certificate contains the information specified in sub. (1) (b), (c), and (d), an official stamp may be affixed to or embossed on the certificate. If a notarial act regarding an electronic record is performed by a notarial officer and the certificate contains the information specified in sub. (1) (b), (c), and (d), an official stamp may be attached to or logically associated with the certificate. 140.15(3)(3) A certificate of a notarial act is sufficient if it meets the requirements of subs. (1) and (2) and satisfies any of the following: 140.15(3)(b)(b) Is in a form otherwise permitted by the law of this state. 140.15(3)(c)(c) Is in a form permitted by the law applicable in the jurisdiction in which the notarial act was performed. 140.15(3)(d)(d) Sets forth the actions of the notarial officer and the actions are sufficient to meet the requirements of the notarial act as provided in ss. 140.05, 140.06, and 140.07 or law of this state other than this chapter. 140.15(4)(4) By executing a certificate of a notarial act, a notarial officer certifies that the officer has complied with the requirements and made the determinations specified in ss. 140.04, 140.05, and 140.06. 140.15(5)(5) A notarial officer may not affix the officer’s signature to, or logically associate it with, a certificate until the notarial act has been performed. 140.15(6)(6) If a notarial act is performed regarding a tangible record, a certificate must be part of, or securely attached to, the record. If a notarial act is performed regarding an electronic record, the certificate must be affixed to, or logically associated with, the electronic record. If the department has established standards pursuant to s. 140.27 for attaching, affixing, or logically associating the certificate, the process must conform to the standards. 140.15 HistoryHistory: 2019 a. 125. 140.16140.16 Short form certificates. The following short form certificates of notarial acts are sufficient for the purposes indicated, if completed with the information required by s. 140.15 (1) and (2): 140.16(1)(1) For an acknowledgment in an individual capacity: State of ....
County of ....
This record was acknowledged before me on ... (date) by .... (name(s) of individual(s)).
.... (Signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
140.16(2)(2) For an acknowledgment in a representative capacity: State of ....
County of ....
This record was acknowledged before me on .... (date) by .... (name(s) of individual(s)) as .... (type of authority, such as officer or trustee) of .... (name of party on behalf of whom record was executed).
.... (Signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
140.16(3)(3) For a verification on oath or affirmation: State of ....
County of ....
Signed and sworn to (or affirmed) before me on .... (date) by .... (name(s) of individual(s) making statement).
.... (Signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
140.16(4)(4) For witnessing or attesting a signature: State of ....
County of ....
Signed [or attested] before me on .... (date) by .... (name(s) of individual(s)).
.... (Signature of notarial officer)
Stamp
.... (Title of office)
[My commission expires: ....]
140.16(5)(5) For certifying or attesting a copy of a record: State of ...
County of ....
I certify or attest that this is a true and correct copy of a record in the possession of ....
Dated: ....
.... (Signature of notarial officer)
Stamp
..... (Title of office)
[My commission expires: ....]
140.16 HistoryHistory: 2019 a. 125.
