The last will and testament of A. B. late of
                county, deceased, declared by him
by word of mouth, on the                day of
            (being then sick of the sickness whereof
he died) in the presence of us the subscribers,
who sign our names as witnesses thereof; which 
words so spoken were as follows (here insert the
very words spoken by the deceased, or as nearly as
can be recollected)--In witness whereof we have
hereto set our hands this                        day of
            anno domini 
                                                            B. C.
                                                            D. E.
                                                            E. F.

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    In the name of God amen.--I A. B. of
            being sick and weak in body, but of
sound mind and memory &c.