AB985,,104 (j) One of the following occurs:

AB985,,105 1. The declarant, or another person at the direction of the declarant, personally delivers or transmits by U.S. mail or commercial courier service the entire signed original declaration to health care professionals 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 declaration to health care professionals to the remote witnesses within a reasonable time. The first remote witness to receive the original declaration to health care professionals signs and dates the original declaration to health care professionals as a witness and forwards the entire signed original declaration to health care professionals by personal delivery or U.S. mail or commercial courier service within a reasonable time to the 2nd remote witness, who signs and dates it as a witness and forwards the entire signed original declaration to health care professionals by personal delivery or U.S. mail or commercial courier service within a reasonable time to the supervising attorney.

AB985,,106 2. The declarant, or another person at the direction of the declarant, personally delivers or transmits by U.S. mail or commercial courier service the entire signed original declaration to health care professionals to the supervising attorney within a reasonable time after execution, and transmits by facsimile or electronic means a legible copy of the entire signed declaration to health care professionals directly to each remote witness within a reasonable time after execution. Each remote witness then signs the transmitted copy of the declaration to health care professionals as a witness and personally delivers or transmits by U.S. mail or commercial courier service the entire signed copy of the declaration to health care professionals to the supervising attorney within a reasonable time after witnessing. The signed original and signed copies together shall constitute one original document, unless the supervising attorney, within a reasonable time after receiving the signed original and signed copies, compiles the signed original and signed copies into one document by attaching the signature pages of each remote witness to the original signed by or on behalf of the declarant, in which case the compiled document shall constitute the original.

AB985,,107 3. The declarant and each of the remote witnesses sign identical copies of the original. The declarant, or another person at the direction of the declarant, and each of the remote witnesses personally deliver or transmit by U.S. mail or commercial courier service the signed originals to the supervising attorney within a reasonable time after execution. All of the signed originals together shall constitute one original document, unless the supervising attorney, within a reasonable time after receiving all signed originals, compiles the originals into one document by attaching the signature pages of each remote witness to the original signed by or on behalf of the declarant, in which case the compiled document shall constitute the original.

AB985,,108 (k) The supervising attorney completes an affidavit of compliance that contains the following information:

AB985,,109 1. The name and residential address of the declarant.

AB985,,110 2. The name and residential or business address of each remote witness.

AB985,,111 3. The address within this state where the declarant was physically located at the time the declarant signed the declaration to health care professionals.

AB985,,112 4. The address within this state where each remote witness was physically located at the time the remote witness witnessed the declarant’s execution of the declaration to health care professionals.

AB985,,113 5. A statement that the declarant and remote witnesses were all known to each other and the supervising attorney or a description of the form of photo identification used to confirm the identity of the declarant and each remote witness.

AB985,,114 6. Confirmation that the declarant declared that the declarant is 18 years of age or older, that the document is the declarant’s declaration to health care professionals, and that the document was being executed as the declarant’s voluntary act.

AB985,,115 7. Confirmation that each of the remote witnesses and the supervising attorney were able to see the declarant, or an individual 18 years of age or older at the express direction and in the physical presence of the declarant, sign, and that the declarant appeared to be 18 years of age or older and acting voluntarily.

AB985,,116 8. A description of the audiovisual technology used for the signing process.

AB985,,117 9. If the declaration to health care professionals was not signed in counterpart, a description of the method used to forward the declaration to health care professionals to each remote witness for signing and to the supervising attorney after signing.

AB985,,118 10. If the declaration to health care professionals was signed in counterpart, a description of the method used to forward each counterpart to the supervising attorney and, if applicable, how and when the supervising attorney physically compiled the signed paper counterparts into a single document containing the declaration to health care professionals, the signature of the declarant, and the signatures of the remote witnesses.

AB985,,119 11. The name, state bar number, and business or residential address of the supervising attorney.

AB985,,120 12. Any other information that the supervising attorney considers to be material with respect to the declarant’s capacity to sign a valid declaration to health care professionals, the declarant’s and witnesses’ compliance with this section, or any other information that the supervising attorney deems relevant to the execution of the declaration to health care professionals.

AB985,,121 (L) The affidavit of compliance is attached to the declaration to health care professionals.

AB985,,122 (m) An affidavit of compliance described in this subsection shall be substantially in the following form:

AB985,,123 AFFIDAVIT OF COMPLIANCE

AB985,,124 State of ....

AB985,,125 County of ....

AB985,,126 The undersigned, being first duly sworn under oath, states as follows:

AB985,,127 This Affidavit of Compliance is executed pursuant to Wis. Stat. § 154.03 (3) to document the execution of the declaration to health care professionals of [name of declarant] via remote appearance by 2-way, real-time audiovisual communication technology on [date].

AB985,,128 1. The name and residential address of the declarant is ....

AB985,,129 2. The name and [residential or business] address of remote witness 1 is ....

AB985,,130 3. The name and [residential or business] address of remote witness 2 is ....

AB985,,131 4. The address within the state of Wisconsin where the declarant was physically located at the time the declarant signed the declaration to health care professionals is ....

AB985,,132 5. The address within the state of Wisconsin where remote witness 1 was physically located at the time the remote witness witnessed the declarant’s execution of the declaration to health care professionals is ....