STATE OF FLORIDA COUNTY OF                                       

I, …..(affiant)….., state under oath that:

1.      The affiant is:

          a person domiciled in and a resident of Florida; or

          a representative authorized to sign on behalf of …..(name of entity)….. which is incorporated, organized, or has its principal place of business in Florida.

2.      The affiant has been informed that …..(name of “testator”)….. has died. At the time of the testator’s death, the affiant or entity the affiant represents was the qualified custodian (the “qualified custodian”) who had custody of the electronic will …..(date of the “electronic will”)……

3.      The qualified custodian deposited the electronic will with the Clerk of Court of                      County, Florida on …..(date)……

4.      The electronic record that contains the electronic will was held in the custody of the qualified custodian at all times from …..(date)….. until it was deposited with the clerk of court.

5.      To the best of the affiant’s knowledge, the electronic record that contains the electronic will was at all times, before being offered to the court, in the custody of a qualified custodian in compliance with section 732.524,

Florida Statutes, and the electronic will has not been altered in any way since the date it was created.

6.      The qualified custodian has (check all that apply):

          posted and maintained a blanket surety bond in compliance with the requirements of section 732.525(1)(a), Florida Statutes; or

          maintained a liability insurance policy in compliance with the requirements of section 732.525(1)(b), Florida Statutes.


Sworn to (or affirmed) and subscribed before me by means of                   

physical presence or                 online notarization, this                    day of        

                   , 20             , by …..(name of person making statement)……

Signature of Notary Public—State of


(Print, Type, or Stamp Commissioned Name of Notary Public)

Personally Known                                       or Produced                           

Identification Type of Identification Produced