VERIFICATION AND CERTIFICATION

I, (NAME OF THE AFFIANT), of legal age, ____, _____ and resident of (address), _________ and
being the sole executor of the last Will and Testament of the late ( testator’s name) after having been
duly sworn to in accordance with law, do hereby depose and say that:

1. I am the petitioner in the above-entitle Petition;

2. I have caused the preparation of the foregoing Petition for the Probate of Will;

3. I have read all the allegations contained therein and that the same are true and correct to my
own knowledge;

4. I have not commenced any other action or proceeding involving the same issued in the Supreme
Court, Court of Appeals, or any other tribunal or agency; and

5. If I should hereafter learn that similar action or proceeding has been filed or is pending before
the Supreme Court, the Court of Appeals, or any other tribunal or agency, I undertake to report
that fact within five (5) days therefrom to this Honorable Office.

IN WITNESS WHEREOF, I have hereto affixed my signature this _ day of ___ 20__ at _______.

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Affiant