Fill and Sign the Minnesota Certificate Trust Form

Prepared By and After Recording Return to: ________________________________ ________________________________ ________________________________ ________________________________ ) ) ) ) ) ) ) ) ) ) ) -------- Above This Line Reserved For Official Use Only---------------- CERTIFICATE OF TRUST (Individual Trustee(s)) STATE OF MINNESOTA COUNTY OF ______________ The undersigned Trustee(s), being first duly sworn, on oath state: 1. The name of the trust is _________________________________________________; 2. The date of the trust instrument is _________________________________________; 3. The name of each grantor is: _____________________________________________________________________ _____________________________________________________________________; 4. The name(s) of each original trustee is/are: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 5. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this certificate: Name _________________________ Address __________________________ ___________________________ 1 ___________________________ Name _________________________ Address __________________________ ___________________________ ___________________________ Name ___________________________ Address __________________________ ___________________________ ___________________________ 6. The trustees are authorized by the instrument to sell, convey, pledge, mortgage, lease, or transfer title to any interest in real or personal property, except as limited by the following: (if none, so indicate): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 7. Additional trust provisions: (provisions included by the grantors or trustees; if none, so indicate) _____________________________________________________________________ _____________________________________________________________________ _________________________________________________________________, and 8. The trust instrument has not been terminated or revoked. 9. Any person may rely upon this Certificate of Trust as proof of the existence of the Trust, and is relieved of any obligation or duty to verify that any transaction entered into by the Trustee(s) is consistent with the terms and conditions of the Trust. 10. This Certificate of Trust is executed as evidence of the existence of the Trust, the terms and conditions of which are incorporated herein by reference. By the terms of the Trust, in the event of the death, resignation, or incapacity of the Primary Trustee(s), the Successor trustee(s) shall become acting trustee(s) without further act, bond, or order. 2 The statements contained in the Trust Certificate are true and correct and there are no other provisions in the trust instrument, or amendments to it, that limit the powers of the trustees to sell, convey, pledge, mortgage, lease, or transfer title to interests in real or personal property. Date: ___________________ Signature of Trustee _______________________________ Print Name ____________________________________ STATE OF MINNESOTA COUNTY OF _________________ This instrument was acknowledged before me on _____________ day of __________________, 20________ by ___________________________________________. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: ____________________ 3