AB985,,5454AFFIDAVIT OF COMPLIANCE AB985,,5656County of .... AB985,,5757The undersigned, being first duly sworn under oath, states as follows: AB985,,5858This Affidavit of Compliance is executed pursuant to Wis. Stat. § 140.147 to document the signing of the [name of estate planning document] of [name of remotely located individual] via remote appearance by 2-way, real-time audiovisual communication technology on [date]. AB985,,59591. The name and residential address of the remotely located individual is .... AB985,,60602. The name and [residential or business] address of the notary public is .... AB985,,61613. The address within the state of Wisconsin where the remotely located individual was physically located at the time the remotely located individual signed the estate planning document is .... AB985,,62624. The address within the state of Wisconsin where the notary public was physically located at the time the notary public witnessed the remotely located individual’s signing of the estate planning document is .... AB985,,63635. The remotely located individual and notary public were known to each other and to the supervising attorney. - OR - The remotely located individual and notary public were not known to each other and to the supervising attorney. The remotely located individual produced the following form of photo identification to confirm his or her identity: AB985,,65656. The following persons were in the same physical location as the remotely located individual during the signing: AB985,,67677. The remotely located individual declared that the remotely located individual is 18 years of age or older, that the document is the remotely located individual’s [name of estate planning document], and that the document was being executed as the remotely located individual’s voluntary act. AB985,,68688. The notary public and the supervising attorney were able to see the remotely located individual sign or another individual on behalf of the remotely located individual sign. The remotely located individual appeared to be 18 years of age or older and acting voluntarily. AB985,,69699. The audiovisual technology used for the signing process was .... AB985,,707010. The estate planning document was not signed in counterpart. The following methods were used to forward the estate planning document to the notary public and to the supervising attorney after signing. - OR - The estate planning document 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 estate planning document, the signature of the remotely located individual, and the notarial act on [date] by [e.g., attaching page 7 from each counterpart signed by the notary public to the back of the estate planning document signed by the remotely located individual]. AB985,,717111. The name, state bar number, and [business or residential] address of the supervising attorney is .... AB985,,727212. [Optional] Other information that the supervising attorney considers to be material is as follows: .... AB985,,7373.... (signature of supervising attorney) AB985,,7474Subscribed and sworn to before me on .... (date) by .... (name of supervising attorney). AB985,,7575.... (signature of notarial officer) AB985,,7777.... (Title of office) AB985,,7878[My commission expires: ....] AB985,,7979(6) If a supervising attorney is required to complete an affidavit in order to execute an estate planning document pursuant to another provision of law, the information required in that affidavit may be combined with the information required in the affidavit of compliance into a single affidavit. AB985,,8080(7) For a notarial act performed under this section, the certificate of notarial act required under s. 140.15 may be in the following short form, if completed with the information required by s. 140.15 (1) and (2): AB985,,8282County of ....