SELF-PROVING AFFIDAVIT
State of _____________________ }
County of _____________________ }
I / We, ____________________________, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Settlor(s) signed and executed the instrument as his/her _________________
[Name of Document] and that he/she signed willingly, and that he/she executed it as
his/her free and voluntary act for the purposes therein expressed, and that each of the
individuals, in the presence of the Settlor(s) was at the time eighteen (18) or more years
of age, of sound mind and under no constraint or undue influence.
Individual’s Signature ___________________________ Date __________________
Witness Signature _________________________ Date __________________
Witness Signature _________________________ Date __________________
NOTARY ACKNOWLEDGMENT
On this ___ of ___________________, 20___, personally appeared the above-named
______________________________________ and acknowledged the foregoing to be
(his/her) free act and deed, before me.
________________________
My Commission Expires: ________________ Notary Public
(Seal) Print ____________________
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
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