STATE OF SOUTH CAROLINA COUNTY OF: IN THE MATTER OF:
) ) ) ) ) )
IN THE PROBATE COURT PROOF OF WILL CASE NUMBER:
WILL CODICIL # The undersigned witness to the will, being duly sworn, says that the instrument exhibited to the undersigned as the Last Will and Testament/Codicil of , deceased, is the same instrument that the decedent executed and that the undersigned and and subscribed as attesting witnesses on the day of , 20 ; that the decedent either signed the instrument in the presence of the attesting witnesses or acknowledged in the presence of the attesting witnesses that the decedent had previously signed the instrument; that the witnesses, in the and that the undersigned believes the decedent was married or eighteen (18) or more years of age and of sound mind at the time.
Signature: Name: Address: Telephone (O): (H):
SWORN to before me this
, Probate Court Judge
FORM #303PC (7/87) 62-3-405, guide to 62-3-406