Fill and Sign the Louisiana Act Donation Form

STATE OF LOUISIANA PARISH OF _______ ACT OF DONATION BEFORE ME, the undersigned Notary Public, duly commissioned and qualified in and for the aforesaid Parish and State, personally came and appeared: _________________ , widower of _________________ , a person of the full age of majority and resident of _______ Parish, Louisiana, whose mailing address is _____________________ , and whose Social Security No. is _________ ; who declared that in consideration of the love and affection he bears for his three children, _________________ , _________________ , and _________________ , he does by these presents make a manual gift and donation inter vivos unto: _________________ , wife of _________________ , a person of the full age of majority and a resident of _______________ , whose mailing address is _____________________ , and whose Social Security No. is _________ ; _________________ , wife of _________________ , a person of the full age of majority and a resident of _______ Parish, Louisiana, whose mailing address is _____________________ , and whose Social Security No. is _________ ; and _________________ , a single person of the full age of majority and a resident of _______ Parish, Louisiana, whose mailing address is _____________________ , and whose Social Security No. is _________ ; hereby appearing for the purpose of accepting the same, of the following described property, to- wit: Each _________ ( _____ ) shares of stock in _________________ of _______ , Louisiana, a Louisiana Corporation. And the said _________________ , _________________ and _________________ do hereby personally appear, in the presence of the undersigned witnesses and me, Notary, and accept the said donation made to each aforementioned, for themselves, their heirs, successors and assigns, and acknowledge due delivery and possession of the above described property so donated to them. The said _________________ expressly dispenses the said _________________ , _________________ and _________________ from collation if ever required by law, the property herein donated being an extra portion delivered unto the said _________________ , _________________ and _________________ . The parties hereto hereby estimate the value of said donated properties to be _________________ AND ___ /100 ($ _______ ) DOLLARS, that is _________ ( _____ ) shares at _________ AND ___ /100 ($ _______ ) DOLLARS per share, and _________ ( _____ ) shares at _________ AND ___ /100 ($ _______ ) per share. _________________ reserves hereunto himself, the usufruct in and to the property herein above including but not limiting to any and all dividends paid. The parties hereto agree to dispense with the production of the Certificate of privileges or mortgages required by Louisiana law and exonerate the undersigned Notary from all liabilities in the premises and further take full cognizance of the fact that they neither requested nor received from the undersigned Notary an opinion with respect to the title to the property hereby donated and finally take full cognizance of the fact that they have supplied the undersigned Notary with the description of all properties herein donated and are satisfied with the said description. THUS DONE AND PASSED by _________________ , _________________ , _________________ and _________________ , in the presence of the undersigned competent witnesses, and me, Notary Public in and for the Parish of _______ , Louisiana, all of whom sign on the _____ day of _____________, 20 ___ , after due reading of the whole. WITNESSES: ____________________________ _____________________________ _________________ ____________________________ _____________________________ _________________ _____________________________ _________________ _____________________________ _________________ ______________________________ NOTARY PUBLIC