IN THE CLERK’S OFFICE OF THE CIRCUIT COURT OF THE ____________ OF _______________.
IN RE: ________________, Deceased
On the _________ day of __________, 20__, a paper dated the _______ day of _______, 20__, purporting to be the will of ______________, deceased, was presented by ____________ and offered for probate.
It appearing to the Clerk that this paper writing was not signed by the deceased in the presence of at least two competent witnesses, present at the same time, who subscribed the paper writing in the presence of the deceased, as required by Va. Code Ann. § 64.2-403, it is therefore ADJUDGED and ORDERED that said paper writing, dated the ________ day of ______, 20__, is not, nor is any part thereof, the true last will and testament of the said _____________, deceased, and is hereby refused and denied to be admitted to probate.
Enter this __ day of ______, 20__.
[or]
IN THE CLERK’S OFFICE OF THE CIRCUIT COURT OF ______________THIS DAY __ OF _________, 20__.
A paper writing purporting to be the Last Will and Testament of (the “Decedent”) dated the __ day of _____, 20__, was this day presented for probate by _________ (the“Proponent”), who made oath thereto.
After being duly sworn, the Proponent testified that the Decedent died on __ the day of _______, 20__, and was at the time of death a resident of __________ City/County, Virginia, owning an estate of real and/or personal property located therein.
After careful review and full consideration of said writing, consisting of ___ pages of paper, dated the __ day of ______, 20__, purporting to be an attested will of the Decedent, the probate of said paper writing purporting to be the Last Will and Testament of ____________ is DENIED for the reasons appearing below:
Said paper writing, marked “REFUSED,” is hereby retained by the Clerk of this Court in its unrecorded documents file pending further action in this matter.