An unsworn declaration under this chapter must be in substantially the following form:
FORM OF UNSWORN DECLARATION
I declare under penalty of perjury under the law of South Dakota that the foregoing is true and correct, and that I am physically located outside the geographic boundaries of the United States, Puerto Rico, the United States Virgin Islands, and any territory or insular possession subject to the jurisdiction of the United States.
Executed on the ____________ day of ________________, ___________,at
(date) (month) (year)
_________________________, __________.
(city or other location, and state)(country)
___________________________________
(printed name)
___________________________________
(signature)