Or. Rev. Stat. § 112.232
(1) As used in this section:
(2)
(3)
(4)
(5) The authorized person shall attach to the will a certificate to be signed by the authorized person establishing that the requirements of this section for valid execution of an international will have been fulfilled. The authorized person shall keep a copy of the certificate and deliver another to the testator. The certificate must be substantially in the following form:
CERTIFICATE
(Convention of October 26, 1973)
1. I, _________ (name, address and
capacity), a person authorized to act
in connection with international wills,
2. certify that on _________ (date)
at _________ (place)
3. (testator) _________ (name, address,
date and place of birth) in my presence
and that of the witnesses
4. (a) _________ (name, address, date
and place of birth)
(b) _________ (name, address, date
and place of birth) has declared that
the attached document is the will of
the testator and that the testator
knows the contents thereof.
5. I furthermore certify that:
6. (a) in my presence and in that of the
witnesses
(1) the testator has signed
the will or has acknowledged
the testator’s signature
previously affixed.
*(2) following a declaration
of the testator stating that
the testator was unable to
sign the will for the following
reason ____________,
I have mentioned this declar-
ation on the will, *and the
signature has been affixed by
_________ (name and address)
7. (b) the witnesses and I have signed
the will;
8. *(c) each page of the will has been
signed by ________
and numbered;
9. (d) I have satisfied myself as to
the identity of the testator and
of the witnesses as designated above;
10. (e) the witnesses met the conditions
requisite to act as such according
to the law under which I am acting;
11. *(f) the testator has requested me
to include the following statement
concerning the safekeeping of
the will: _______________
12. PLACE OF EXECUTION
13. DATE
14. SIGNATURE and, if necessary, SEAL
*to be completed if appropriate
[1981 c.481 §2; 1993 c.98 §2]