RULE 5.930. AFFIDAVIT OF QUALIFIED CUSTODIAN OF ELECTRONIC
WILL

STATE OF FLORIDA
COUNTY OF

I, .....(affiant)....., state under oath that:

1. The affiant is:

a person domiciled in and a resident of Florida; or

a representative authorized to sign on behalf of .....(name of
entity)..... which is incorporated, organized, or has its principal place of
business in Florida.

2. The affiant has been informed that .....(name of “testator”)..... has
died. At the time of the testator’s death, the affiant or entity the affiant
represents was the qualified custodian (the “qualified custodian”) who had
custody of the electronic will .....(date of the “electronic will”)......

3. The qualified custodian deposited the electronic will with the Clerk
of Court of County, Florida on .....(date)......

4. The electronic record that contains the electronic will was held in
the custody of the qualified custodian at all times from .....(date)..... until it was
deposited with the clerk of court.

5. To the best of the affiant’s knowledge, the electronic record that
contains the electronic will was at all times, before being offered to the court, in
the custody of a qualified custodian in compliance with section 732.524,
Florida Statutes, and the electronic will has not been altered in any way since
the date it was created.

6. The qualified custodian has (check all that apply):

posted and maintained a blanket surety bond in compliance with
the requirements of section 732.525(1)(a), Florida Statutes; or

maintained a liability insurance policy in compliance with the
requirements of section 732.525(1)(b), Florida Statutes.

Affiant
Sworn to (or affirmed) and subscribed before me by means of
physical presence or online notarization, this day of
, 20 , by .....(name of person making statement)......

Signature of Notary Public—State of
Florida
(Print, Type, or Stamp
Commissioned Name of Notary
Public)

Personally Known or Produced

Identification Type of Identification Produced