State of
County of
This Certificate of Trust Form is executed on , by the undersigned Trustee of the following trust:
TRUST. The trust, known as (the "Trust") is currently in existence and was created on .
The Trust has not been terminated, revoked, modified, or amended in any manner that would cause the representations contained in this Certificate of Trust to be incorrect.
Trust identification number:
SETTLOR. The settlor of the Trust (the "Settlor") is as follows:
, with a mailing address of .
TRUSTEE. The trustee of the Trust (the "Trustee") is as follows:
, with a mailing address of .
SUCCESSOR TRUSTEE. The successor trustee of the Trust (the "Successor Trustee") is as follows:
, with a mailing address of .
TRUST PROPERTY. The Trust holds the following property and assets:
POWERS. The Trustee has:
REVOCATION. The Trust is considered:
EXECUTION. I, the undersigned, declare that this Certificate of Trust Form has been examined by me, and its contents are true and correct.
____________________________
(Place for signature)
State of
Acting in the county of
Sworn to and subscribed before me on ___________________________.
___________________________________
Place for signature
______________________________________
Notary public's name and seal