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STATE OF FLORIDA
COUNTY OF ST. LUCIE
We, HAROLD W. BURNARD, Ben L. Bryan, Jr. ' and
Ruth N. Sells , the Testator and the witnesses respec-
tively, whose names are signed to the attached or foregoing instrument,
.being first~duly sworn, do hereby declare to the undersigned officer
that the Testator signed the instrument as his Last Will and that he
signed voluntarily and that each of the witnesses in the presence of ~
the Testator, at his request, and in t11e 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 constra'int or undue influence. _
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Testator
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itness
Witness
Subscribed and acknowledged before me by HAROLD W. BURNARD, ~
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Testator, and subscribed and sworn to before me by Ben L. Bryan, Jr.
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~ and Ruth N. Sells , witnesses, on ?
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; July 29th , 1976.
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