Fill and Sign the Form New York State Unified Court

FINANCIAL ACCOUNT TRANSFER TO TRUST To: THIS Assignment, is being made on this the ________ day of _______________, 20_____, by _______________________, _______________________ County, State of New York, as the Assignor(s), whether one or more, and _______________________, as Trustee of THE _______________________ REVOCABLE TRUST dated _______________, as the Assignee. Assignor(s) do hereby assign, convey, and deliver to the Assignee all of the Assignor’s right, title, and interest in and to the following described property: Checking Account No(s): at . Checking Account No(s): at . Savings Account No(s): at . Savings Account No(s): at . Account No(s): at . Account No(s): at . Account No(s): at . Brokerage Account No(s): at . This assignment includes, but is not limited to, all cash and securities held in said Accounts. These account shall hereafter be titled in the name of _______________________, as Trustee of THE _______________________ REVOCABLE LIVING TRUST, with an address of _______________________. TO HAVE AND TO HOLD unto the Trustee and his or her successors and assigns forever. DATED this the _____ day of ______________________, 20___. __________________________________ Trustor Signature Print Name: _______________________ __________________________________ Trustor Signature Print Name: _______________________ STATE OF NEW YORK COUNTY OF ___________________On the ____________ day of _________________ in the year __________ before me, the undersigned, personally appeared _____________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________