Fill and Sign the Nevada 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 NEVADA 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 powers of the Trustee(s) are: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 2 6. The Trustee is Irrevocable Revocable. If Revocable, the power to revoke the trust is held by the following individual(s): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 7. The authority of co-trustees to sign and the number of signatures of co-trustees required to act are: a. Authority of co-trustees to sign: ______________________________________. Signatures Required: All One Two Other ________ 8. The Trust’s Taxpayer Identification Number is: _______________________________. This number is a: Social Security Number Employer ID Number 9. The name and 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 __________________________ ______________________________________________________ 10. 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): _____________________________________________________________________ 3 _____________________________________________________________________ _____________________________________________________________________; 11. Title to trust assets shall be taken in the following manner: ; 12. Additional trust provisions: (provisions included by the grantors or trustees; if none, so indicate) _____________________________________________________________________ _____________________________________________________________________ _________________________________________________________________, and 13. The trust instrument has not been terminated, revoked or amended to make any representations contained in the Certification incorrect. 14. 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. 15. 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. 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 ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ 4 STATE OF NEVADA COUNTY OF ________________________This instrument was acknowledged before me on ________ day of _____________, 20____, by ________________________________________. (Seal) Notary Public ________________________ Printed Name: _______________________ My Commission Expires: ____________________ STATE OF NEVADA COUNTY OF ________________________ This instrument was acknowledged before me on ________ day of _____________, 20____, by _________________________________________. (Seal) Notary Public ________________________ Printed Name: _______________________ My Commission Expires: ____________________ STATE OF NEVADA COUNTY OF ________________________ This instrument was acknowledged before me on ________ day of _____________, 20____, by ___________________________________________. (Seal) Notary Public ________________________ 5 Printed Name: _______________________ My Commission Expires: ____________________