Fill and Sign the Charitable Remainder Trust Form

The John Doe Charitable Remainder Annuity Trust On this the ___day of ______________, 20____, I, _______________ (the "Donor"), desiring to establish a charitable remainder annuity trust , within the meaning of Rev. Proc. 2003-53 and § 664(d)(1) of the Internal Revenue Code (the "Code"), hereby enter into this trust agreement with __________________________ as the initial trustee (the "Trustee"). This trust shall be known as the ______________________________ . 1. Funding of Trust The Donor hereby transfers and irrevocably assigns, on the above date, to the Trustee the property described in Schedule A, and the Trustee accepts the property and agrees to hold, manage, and distribute the property under the terms set forth in this trust instrument. 2. Payment of Annuity Amount In each taxable year of the trust during the annuity period, the Trustee shall pay to my wife _______________________ (the "Recipient") an annuity amount equal to ______ % of the initial net fair market value of all property transferred to the trust , valued as of the above date (that is, the date of the transfer). The first day of the annuity period shall be the date the property is transferred to the trust and the last day of the annuity period shall be the date of the Recipient's death. The annuity amount shall be paid in equal quarterly installments at the end of each calendar quarter from income, and to the extent income is not sufficient, from principal. Any income of the trust for a taxable year in excess of the annuity amount shall be added to principal. If the initial net fair market value of the trust assets is incorrectly determined, then within a reasonable period after the value is finally determined for federal tax purposes, the Trustee shall pay to the Recipient (in the case of an undervaluation) or receive from the Recipient (in the case of an overvaluation) an amount equal to the difference between the annuity amount(s) properly payable and the annuity amount(s) actually paid. 3. Proration of Annuity Amount The Trustee shall prorate the annuity amount on a daily basis for any short taxable year. In the taxable year of the trust during which the annuity period ends, the Trustee shall prorate the annuity amount on a daily basis for the number of days of the annuity period in that taxable year. 4. Distribution to Charity At the termination of the annuity period, the Trustee shall distribute all of the principal and income of the trust (other than any amount due the Recipient or the Recipient's estate under the provisions above) to ____________________________ ., a (name of state) non-profit corporation (the "Charitable Organization"). If the Charitable Organization is not an organization described in Sections 170(c), 2055(a), and 2522(a) of the Code at the time when any principal or income of the trust is to be distributed to it, then the Trustee shall distribute the then principal and income to one or more organizations described in Sections 170(c), 2055(a), and 2522(a) of the Code as the Trustee shall select, and in the proportions as the Trustee shall decide, in the Trustee's sole discretion. 5. Additional Contributions No additional contributions shall be made to the trust after the initial contribution. 6. Prohibited Transactions The Trustee shall not engage in any act of self-dealing within the meaning of Section 4941(d) of the Code, as modified by § 4947(a)(2)(A) of the Code, and shall not make any taxable expenditures within the meaning of § 4945(d) of the Code, as modified by § 4947(a)(2)(A) of the Code. 7. Taxable Year The taxable year of the trust shall be the calendar year. 8. Governing Law The operation of the trust shall be governed by the laws of ____________ (name of state ) . However, the Trustee is prohibited from exercising any power or discretion granted under such laws that would be inconsistent with the qualification of the trust as a charitable remainder annuity trust under § 664(d)(l) of the Code and the corresponding regulations. 9. Limited Power of Amendment This trust is irrevocable. However, the Trustee shall have the power, acting alone, to amend the trust from time to time in any manner required for the sole purpose of ensuring that the trust qualifies and continues to qualify as a charitable remainder annuity trust within the meaning of § 664(d)(1) of the Code. 10. Investment of Trust Assets Nothing in this trust instrument shall be construed to restrict the Trustee from investing the trust assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of trust assets. The parties have signed this agreement on the day and year first above written. WITNESS our signatures as of the day and date first above stated. By:______________________________ ______________________ (Name and Office in Bank) JOHN DOE Acknowledgments (form of acknowledgment may vary by state) Attach Schedule A