AFFIDAVIT OF ATTESTING WITNESSES - PROBATE STATE OF ILLINOIS 3716 (Rev.4/17) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN RE THE ESTATE OF CASE NUMBER DECEASED AFFIDAVIT OF ATTESTING WITNESSES File Stamp Here Each of the undersigned, being attesting witnesses to the Will of decedent in this cause, do on oath state: A. That each of the undersigned was present on , and saw the testator, in our presence, sign the Will to which the Affidavit is attached (or a facsimile which accurately reproduces said Will is hereto attached), or that the testator acknowledged said Will to the undersigned; B. That said Will was attested by each of the undersigned in the presence of the testator; C. That each of the undersigned believed the testator to be of sound mind and memory at the time of signing or acknowledging said Will. Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Email: Pro Se Subscribed and sworn to before me Date Circuit Clerk or Notary Public CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com