Rhode Island

State of Rhode Island County of _______________ In _______________, on this ______ day of ________________, 20______, before me personally appeared the undersigned, who, being duly sworn, depose and say that: they witnessed the execution of the will of {testatorName}; that the signature to the will is in the handwriting of the testator or was made by some other person for the testator, in the testator's presence and by the testator's express direction; that the testator so subscribed the will and declared the same to be the testator's last will in their presence; that they thereafter subscribed the same as witnesses in the presence of the testator and in the presence of each other; that at the time of execution of the will the testator appeared to be of sound mind and eighteen (18) years of age or over; and that the signatures of the witnesses on the will are genuine. _______________ Witness _______________ Witness Subscribed and sworn to before me on the day and date first above written. _______________ Notary Public

R.I. Gen. Laws §33-6-1: a beneficial devise, legacy, estate, interest, gift, or appointment made by a will to a person who attests its execution, or to anyone claiming under that person, is null and void, excepting only charges and directions for the payment of debts; the attesting person remains admissible as a witness to prove the will. The section has no saving clause: it makes no exception for extra disinterested witnesses and gives the witness no intestate-share carve-out, so a beneficiary who witnesses a Rhode Island will forfeits the gift entirely while the will itself remains valid. Under §33-6-4, being named executor of or trustee under the will does not disqualify a person from witnessing it.

WARNING TO PERSON EXECUTING THIS DOCUMENT This is an important legal document which is authorized by the general laws of this state. The powers granted by this document are broad and sweeping. They are defined in §§ 18-16-1 to 18-16-12, both inclusive, of the general laws in chapter 18-16 entitled "Rhode Island Short Form Power of Attorney Act." The use of the short form power of attorney is strictly voluntary, and chapter 18-16 specifically authorizes the use of any other or different form of power of attorney upon mutual agreement of the parties concerned. ADDITIONAL DISCLOSURES (not part of the R.I. Gen. Laws §18-16-2(a) Notice reproduced above): This Power of Attorney is not the statutory short form described in R.I. Gen. Laws §18-16-2. Under §18-16-2(e) an instrument is a "statutory short form power of attorney" only if it is in writing, has been duly acknowledged by the principal, and contains the exact wording of clause First of the §18-16-2(a) form. This document grants its powers in its own words instead, which chapter 18-16 expressly permits: §18-16-2(c) provides that no provision of the chapter bars the use of any other or different form of power of attorney desired by the parties concerned. This Power of Attorney is durable because it says so on its face; the statutory form at R.I. Gen. Laws §18-16-2(a) carries the sentence "This power of attorney shall not be affected by the subsequent incompetency of the donor." Your agent cannot make health-care decisions for you under this instrument. To grant health-care decision-making authority, execute a separate "Durable Power of Attorney for Health Care" under R.I. Gen. Laws §23-4.10-2. You may revoke this Power of Attorney at any time while you are of sound mind by delivering written notice of revocation to your agent and to any third party who has relied on the Power of Attorney. Chapter 18-16 is the Rhode Island Short Form Power of Attorney Act referred to in the Notice above. If there is anything about this document that you do not understand, you should ask a lawyer to explain it to you before you sign.

R.I. Gen. Laws §23-4.10-2: the durable power of attorney for health care must be signed by two qualified adult witnesses or acknowledged before one notary public. None of the following may be used as a witness: a person designated as agent or alternate agent, a health care provider, an employee of a health care provider, the operator of a community care facility, or an employee of an operator of a community care facility. At least one of the witnesses, or the notary public, must also declare under penalty of perjury that the signer is not related to the principal by blood, marriage, or adoption and is not entitled to any part of the principal's estate under a will now existing or by operation of law; the second witness need not be disinterested. The living-will declaration under R.I. Gen. Laws §23-4.11-3(a) has its own rule and requires two subscribing witnesses who are not related to the declarant by blood or marriage.