Fill and Sign the Beneficiary Account Form

Irrevocable Trust as Designated Beneficiary of an Individual Retirement Account Trust agreement made on ______________________________ (date), between _________________________________ (Name of Trustor), of __________________________ ______________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter called Trustor, and ____________________________________ (Name of Trustee), of _______________________ ______________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter called Trustee. For and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Trustor and Trustee agree as follows: 1. Trust Estate Trustor transfers and delivers to Trustee the property described in Exhibit A, which is attached and incorporated by reference. The receipt of the property is hereby acknowledged by Trustee . This Trust shall also be the designated beneficiary of an Individual Retirement Account (IRA) described as follows (describe) ______________________________________________ ___________________________________________________________________________________________________________________________________________________________. Trustee shall have the authority and discretion to exercise any elections and to distribute said IRA to the beneficiaries of this Trust, in order to meet the needs of the beneficiaries of this Trust and obtain maximum income and estate tax savings available with respect to the IRA. 2. Trustee’s Rights in Property Trustee shall be vested with all rights, powers, options and privileges in and to the trust estate, and may exercise any and all of such rights, powers, options, and privileges as fully as any owner of all or any part of the Trust property might. Trustor shall execute any and all instruments necessary to permit Trustee to exercise any such rights, powers, options, or privileges. 3. Disposition During the Lifetime of Trustor and Payment of Premiums During the lifetime of Trustor, Trustee shall hold the Trust’s property and manage, invest, and reinvest such property, collect the income derived from said property, and render payment of all proper charges and expenses of the Trust. No part of the principal or income of the Trust shall be distributed to any beneficiary prior to Trustor’s death. 5. Disposition After the Death of Trustor On the death of Trustor, Trustee shall distribute the income and principal of the Trust Estate to __________________________________ (Name of Primary Beneficiary) in such amounts as said Trustee, in said Trustee's discretion, deems to be in the best interest of said Primary Beneficiary . Said Trust shall terminate upon the death of the Primary Beneficiary, at which time all of the corpus and accrued income shall vest in _________________________________ (Name of Secondary Beneficiary); provided, however, if said Secondary Beneficiary shall predecease said Primary Beneficiary, the proceeds from said Trust shall vest in Secondary Beneficiary’s heirs at law at that time. 6. Additions to Trust Trustor, and any other person, shall have the right at any time to add to this Trust any other property that is acceptable to Trustee. Said other property, when received and accepted by Trustee, shall become part of the Trust Estate. 7. Irrevocability of Trust This Agreement and the Trust created by it shall be irrevocable, and shall not be altered, amended, revoked or terminated by Trustor or any other person. No part of the principal or income of the Trust shall ever revert to, or be used for, the benefit of Trustor, or be used to satisfy any legal obligations of Trustor. Trustor renounces for himself/ herself and his/ her estate any interest, either vested or contingent, including any reversionary right or possibility of reverter, in the principal and income of the Trust, and any power to determine or control, by alteration, amendment, revocation, termination, or otherwise, the beneficial enjoyment of the principal or income of the Trust. 8. Powers of Trustee In addition to all other powers and discretions granted by law or by this agreement, Trustee shall have the following powers and discretions, all of which shall be exercised in a fiduciary capacity: A. To arrange for the automatic application of dividends in reduction of premium payments, with regard to all policies of insurance held in the trust estate. Otherwise, the dividends shall be treated as income and shall be applied to the payment of the premiums. B. The Trustee shall have power to invest and reinvest the trust property in bonds, stocks, notes, or other property, real or personal, suitable for the investment of trust funds; to register property in the name of a nominee without restriction; to vote in person or by general or limited proxy, or refrain from voting, any corporate securities for any purpose, except that any security as to which the Trustee's possession of voting discretion would subject the issuing company or the Trustee to any law, rule, or regulation adversely affecting either the company or the Trustee's ability to retain or vote company securities, shall be voted as directed by the Trustor, if living, otherwise by the beneficiaries then entitled to receive or have the benefit of the income from the Trust; to lease (for any period of time though commencing in the future or extending beyond the term of the trust), sell, exchange, mortgage, or pledge any or all of the trust property as the Trustee deems proper; to borrow from any lender, including a Trustee individually; to employ agents, attorneys and proxies; to compromise, contest, prosecute or abandon claims; to divide or distribute in cash or in kind, or partly in each, or in undivided interests or in different assets or disproportionate interests in assets, to value the trust property for such purposes, and to sell any property in order to make division or distribution. C.The Trustee is authorized to establish out of income and credit to principal reasonable reserves for depreciation, obsolescence and depletion. D. The Trustee may transfer the situs of any trust property to any other jurisdiction as often as the Trustee deems it advantageous to the Trust, appointing a substitute Trustee to itself to act with respect to it. In connection with that the Trustee may delegate to the substitute Trustee any or all of the powers given to the Trustee, which may elect to act as advisor to the substitute Trustee and shall receive reasonable compensation for so acting. The Trustee may remove any acting substitute Trustee and appoint another, or reappoint itself, at will. 9. Limitation on Powers Notwithstanding the foregoing and any other provision of this trust agreement, no power exercisable by T rustee shall be construed so as to enable Trustee, Trustor, or any other person to purchase, exchange, or otherwise deal with or dispose of the principal of the trust estate or the income from the trust estate for less than an adequate consideration in money or money's worth, or to enable Trustor to borrow the principal or income, directly or indirectly, without adequate interest or security. No person other than Trustee acting in a fiduciary capacity shall have the power to vote or direct the voting of stock or other securities, to control the investment of trust funds either by directing investments or reinvestments or by vetoing proposed investments or reinvestments, or to permit any person to reacquire the trust principal by substituting other property of an equivalent value. 10. Compensation of Trustee The Trustee shall be reimbursed for all reasonable expenses incurred in the management and protection of the trust and shall receive fair compensation for its services. The Trustee's regular compensation shall be charged against income during the Trustor’s lifetime and subsequently half against income and half against principal, except that the Trustee shall have full discretion at any time or times to charge a larger portion or all against income without being limited to circumstances specified by state law. 11. Successor Trustees Trustee shall have the power to appoint a successor trustee. If Trustee shall die, resign, become incapacitated, or refuse to act further as Trustee under this Agreement, without having appointed a successor, the successor trustee shall be ___________________________________ (Name of Successor Trustee) . Any successor trustee shall have all the duties and powers assumed and conferred in this Agreement on Trustee, including the power to appoint a successor. Any appointment of a successor trustee shall be made by an acknowledged instrument delivered to Trustor, if living, and to ____________________________________ (Name of Successor Trustee) , should Trustor then be deceased. 12. Trustee’s Bond No trustee or successor trustee shall be required to give any bond or other security. 13. Accounting Trustee shall maintain accurate accounts and records, and shall render (e.g., annual) __________________ statements to Trustor while living and subsequently to the adult beneficiary or beneficiaries who may then be entitled to receive income under this Agreement. The statements shall show receipts and disbursements of principal and income of the trust estate. Written approval of the statement by the person or persons entitled to the accounting shall, as to all matters and transactions stated in or shown by the statement, be final and binding on all persons, whether in being or not, who are then or may later become interested in or entitled to share in either the income or the principal of this Trust. However, nothing contained in this section shall be deemed to give such person acting in conjunction with Trustee the power to alter, amend, revoke, or terminate this Trust. 14. Situs of Trust The situs of this Trust shall be the State of ____________________ (name of state), and the construction, validity, and effect of this agreement and the rights and duties of the beneficiaries and the trustees shall be governed by the laws of the State of __________________ (name of state) . However, the Trustee shall have the power to change the situs of this Trust by written instrument signed and acknowledged by the Trustee, without any need to obtain the approval of any court, and to elect that the Trust shall be subject to the jurisdiction of, and to move the assets of such Trust to, any state as the new situs of the Trust. If such election shall be made, such Trust shall be administered, and the validity and effect of the provisions of this instrument applicable to such Trust shall be determined, in accordance of the laws of the new situs. 15. Governing Law This agreement shall be governed by the laws of ______________________ (name of state) . The parties have executed this Agreement on the day and year first above written. __________________________________ _________________________________ Trustor Trustee (Acknowledgments before Notary Public) (Attach Exhibits)