Fill and Sign the Revocable Funeral Trust Prearranged Funeral Trust Account Form

Revocable Funeral Trust -- Prearranged Funeral Trust Account Account No.: ____________________ (account number) The undersigned _______________________ (Name of Trust or) do hereby open individual Trustee savings account, No. ____________________ (Account number) , in ____________________________ (Name of Bank) , located at _________________________ _____________________________________ (street address, city, county, state, zip code) , hereinafter referred to as the Bank, as Trustee for ______________________ (name of funeral director) , of __________________________________________________________________ ______________ (street address, city, county, state, zip code) , hereinafter referred to as the Beneficiary. 1. Revocability of Trust I declare that the savings account shall be held by me in Trust for the Beneficiary , reserving to myself the right to have any interest paid or dividend declared on the savings account paid to me, and to revoke the Trust in whole or in part at any time by executing and delivering to the Bank a request for withdrawal of the whole or a part of the savings account. The Trust shall be revoked as to the whole or part to which the request relates. 2. Authority The Bank is authorized, as to such account, to act without further inquiry, in accordance with any writing bearing my signature as it appears at the end of this instrument; to credit earnings to the account unless written instructions to the contrary are given; and to supply any needed endorsement on any check or other instrument tendered for credit to the account. 3. Death of Trustor A. At my death, the Bank shall pay the savings account to the designated Beneficiary if then living. If more than one person is designated as the Beneficiary , the Bank shall pay the savings account equally to those designees living at my death or all to a sole surviving designee. B. If no Beneficiary so named is living at my death, the Bank shall pay the savings account to my estate. 4. Personal Information regarding Trustor. My Social Security Number is _______________ ( social security number of Trustor) . My date of birth __________________ (date of birth of Trustor) . WITNESS my signature this the _____ day of ____________, 20______. _________________________ (P rinted Name of Trustor) _________________________ (Signature of Trustor)