8. The principal declared that the principal is 18 years of age or older, that the document is the principal’s power of attorney, and that the document was being executed as the principal’s voluntary act.

9. Each of the remote witnesses and the supervising attorney were able to see the principal, or another individual 18 years of age or older at the express direction and in the physical presence of the principal, sign. The principal appeared to be 18 years of age or older and acting voluntarily.

10. The audiovisual technology used for the signing process was ....

11. The power of attorney was not signed in counterpart. The following methods were used to forward the power of attorney to each remote witness for signing and to the supervising attorney after signing. - OR - The power of attorney was signed in counterpart. The following methods were used to forward each counterpart to the supervising attorney. [If applicable] - The supervising attorney physically compiled the signed paper counterparts into a single document containing the power of attorney, the signature of the principal, and the signatures of the remote witnesses on [date] by [e.g., attaching page 7 from each counterpart signed by a remote witness to the back of the power of attorney signed by the principal].

12. The name, state bar number, and business or residential address of the supervising attorney is ....

13. [Optional] Other information that the supervising attorney considers to be material is as follows: ....

.... (signature of supervising attorney)

Subscribed and sworn to before me on .... (date) by .... (name of supervising attorney).

.... (signature of notarial officer)

.... (Title of office)

[My commission expires: ....]

853.03 (2) (c) For purposes this subsection, “conscious presence” includes the simultaneous remote appearance by 2-way, real-time audiovisual communication technology if all of the following conditions are satisfied:

1. The signing is supervised by an attorney in good standing licensed by this state. The supervising attorney may serve as one of the remote witnesses.

2. The testator attests to being physically located in this state during the 2-way, real-time audiovisual communication.

3. Each remote witness attests to being physically located in this state during the 2-way, real-time audiovisual communication.

4. The testator and each of the remote witnesses identify themselves. If the testator and remote witnesses are not personally known to each other and to the supervising attorney, the testator and each of the remote witnesses display photo identification.

5. The testator identifies anyone else present in the same physical location as the testator and, if possible, the testator makes a visual sweep of the testator’s physical surroundings so that the supervising attorney and each remote witness can confirm the presence of any other person.

6. The testator displays the will, confirms the total number of pages and the page number of the page on which the testator’s signature will be affixed, and declares to the remote witnesses and the supervising attorney all of the following:

a. That the testator is 18 years of age or older.

b. That the document is the testator’s will.

c. That the document is being executed as a free and voluntary act.

7. The testator, the testator with the assistance of another person 18 years of age or older with the testator’s consent, or another person 18 years of age or older signing in the testator’s name at the testator’s direction and in the testator’s physical presence, executes the will in a manner that allows each of the remote witnesses and the supervising attorney to see the execution.

8. The audiovisual communication technology used allows communication by which a person is able to see, hear, and communicate in an interactive way with another person in real time using electronic means, except that if the testator, a remote witness, or the supervising attorney has an impairment that affects hearing, sight, or speech, assistive technology or learned skills may be substituted for audio or visual if it allows that person to actively participate in the signing in real time.

9. The will indicates that it is being executed pursuant to this section.

10. One of the following occurs:

a. The testator, or another person at the direction of the testator, personally delivers or transmits by U.S. mail or commercial courier service the entire signed original will to the supervising attorney within a reasonable time after execution. The supervising attorney then personally delivers or transmits by U.S. mail or commercial courier service the entire signed original will to the remote witnesses within a reasonable time. The first remote witness to receive the original will signs the original will as a witness and forwards the entire signed original will by personal delivery or U.S. mail or commercial courier service within a reasonable time to the 2nd remote witness, who signs it as a witness and forwards the entire signed original will by personal delivery or U.S. mail or commercial courier service within a reasonable time to the supervising attorney.