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STATE OF FLORIDA H ~ b C
COUNTY OF ST. LUCIE '
We, the undersignea, testator and w3tnesses respectively,
whose names are signed to the attached instrument, being first
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~duly sworn, do hereby declare to the undersigned officer that ~ ~
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the testator signed the instrument as his last will and that he
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signed voluntari2.y and that each of the witnesses in the presence
of the testator, at his request; and in the presence of each
other signed the will as a witness and that to the best of the
knowledge of each witness the testator was at that time 18 or
more years of age, of sound mind and under no constraint or undue
influence. .
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Jo S ins i, Sr. ,
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Witne s ~
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Witness j
Subscribed and acknowledqed before me by JOffi~1 J.
SIWINSKI, SR., the testator, and subscribed and sworn to before
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me by the witnesses above on this~day of January, I97~.
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Notary Pu c S ate o F ori a '
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At Large t
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My Commission Expires: ~ _
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NOTA ~ ~ ~ • £
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CE7VERILL iNSURJtNCE UNDEDRWR(iTER4r IMCr ' ~ .
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fIlEO AMO RECORUEU ~
ST_ IUCIE COUNTr fLa.
RCC: R POiTRAS ~ ;
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