Fill and Sign the Indiana as the Assignors Whether One or More and as Trustee Form

FINANCIAL ACCOUNT TRANSFER TO TRUST To: THIS Assignment, is being made on this the ________ day of _______________ , 20 _____ , by _______________________ , _______________________ County, State of Indiana, 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 A ssignor’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 . Acc ount 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 INDIANA COUNTY OF __________________ Before me, the undersigned, a Notary Public, in and for said County and State, this __________ day of _________________, _________, personally appeared _________________________________________, said person being over the ag e of 18 years, and acknowledged the execution of the foregoing instrument. ___________________________ Notary Public Print Name: _________________ My commission expires: _____________________