The undersigned having been duly sworn to act as the appraisers of _________ property of _________ of _________ and to _________, do hereby make and subscribe the following return: We viewed and appraised at the values annexed the following articles of personal property: _________, which we declare to be a fair valuation. We hereby certify that we are not related by blood or marriage to _________ and have no interest, near or remote, in _________. Given under our hands and seals this _________ day of _________, _________[date].