Fill and Sign the Mississippi Certificate Form

1 Prepared By and After Recording Return to: ________________________________ ________________________________ ________________________________ ________________________________ ) ))))))))))--------Above This Line Reserved For Official Use Only---------------- CERTIFICATE OF TRUST (Individual Trustee(s)) STATE OF MISSISSIPPI 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 and mailing address of each grantor is: Name _________________________ Address __________________________ ______________________________________________________ Name _________________________ Address __________________________ ______________________________________________________ Name ________________________ Address __________________________ ______________________________________________________ 2 4. The name and mailing address of each trustee empowered to act under the trust instrument at the time of execution of this certificate: Name _________________________ Address __________________________ ___________________________ ___________________________ Name _________________________ Address __________________________ ______________________________________________________ Name ________________________ Address __________________________ ______________________________________________________ 6. The legal descriptions of all interests in real property owned by or conveyed to the trust: [list or attach as an Exhibit] 7. The anticipated date of termination of the Trust is: ____________________ Unknown 8. The general powers of the Trustee(s) are as follows: (list) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 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, 3 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. 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 Grantor _____________________________ Print Name ____________________________________ STATE OF MISSISSIPPI COUNTY OF _________________ Personally appeared before me, the undersigned authority in and for said county and state, on this __________ day of ___________________________, 20____, within my jurisdiction, the within named ______________________________, who acknowledged that (he/she/they) executed the above and foregoing instrument. Notary Public _______________________ Printed Name: _______________________ My Commission Expires: _____________________ Signature of Trustee ___________________ Print Name __________________________ STATE OF MISSISSIPPI COUNTY OF _________________ Personally appeared before me, the undersigned authority in and for said county and state, on this __________ day of ___________________________, 20____, within my jurisdiction, the within named ______________________________, who acknowledged that (he/she/they) executed the above and foregoing instrument. Notary Public ________________________ Printed Name: _______________________ My Commission Expires: _____________________