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AFFIDAVIT W ~ sTATE OF CONNECTICUT
PROOF OF WILD. CQURT OF PROBATE '
OR CODICIL' ~ 1
PRCJ2 NNr 11.71 > ~ ~/7 ~
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T0: Court of Probate, District of aIQ$ District No. 0 7
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OATi O/ INSTRW6NT HEINO PROVRD T011Ri wND aTATIi O1tERt INIiTRUYiNT SAS ILx6CUTtD
August 30, 1960 areern+ioh, Conneatiaut
IN THE MATTER OF PROVING THE
~ Last Will and Testament of said deceased.
_ Codicil to the Last Will and Testament of said
(First. Second, eta) '
deceased. dated
(Date of Last Will and Testament)
HAVING BEEN DULY SWORN, THE UNDERSIGNED DEPOSES AND SAYS THAT:
The above-named deceased, hereinafter referred to as TESTATOR, executed the instrument
hereunto annexed. or the original of the attested facsimile of the same hereunto annexed, on the
date and at the place above written. and declared the same to be an instrument of the purport
and intendment as above indicated. in the presence of the undersigned and each other subscribing
witness to said instrument;
The tmdersigned thereupon subscribed said instrument as a witness at the request of the
TESTATOR as did each other subscribing witness is the presence of the TESTATOR and is the
presence of each other;
At the time of execution of said instrument the TESTATOR was at least eighteen years of
age and of sound mind and memory and competent is every respect to melee a will and was not
.under any restraint;
The undersigned makes this affidavit after the death of said TESTATOR at the request of
the executor or a person interested under the will or codicil.
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~ Dated at Venice, Florida this ~ day of December 19 7
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(Signature of Subscribing sal :i
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402 Blaokbtu~n Boulevard
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Venice, Florida 33595
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DATE SIGNED (Notary PuD1ie (GWo date comati..ion .:pirea) Raeordad Probate Reeorda
SuBSCRiHED AND S10RN /78 Notory ?ubCic. Stota of Florida of large
TO HEPORE ME Mr Coauaissiew E:puts Joa. L 1971
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A F FIDAVIT W PROOF OF WILL OR CODICIL 80GK JlJO PAGE ~~c~t7J w..•t, ct.r~
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