Fill and Sign the Revocation of Trust and Acknowledgment of Receipt of Notice of Revocation by Trustee Form

Revocation of Trust and Acknowledgment of Receipt of Notice of Revocation by Trustee To: _____________________________________________________ (Name of Trustee) ________________________________________________________________________ ______________________________________________________ (Address of Trustee) I, ___________________________________________________ (Name of Trustor) of ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________ (street address, city, county, state, zip code) , am the Trustor pursuant to the [e.g., Declaration of Trust of (Name of Trustor) dated (date) for the benefit of (Name of Beneficiaries)] ________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________, in which you are designated as Trustee. As Trustor under said Trust, I do hereby revoke the powers and trusts created and conferred by the Trustor in that trust instrument, pursuant to and in exercise of the right to revoke reserved to Trustor in Section _____________ of that trust instrument. I hereby direct you, as Trustee, to turn over and deliver to me all property held by you subject to the terms and provisions of the trust instrument, together with all accumulations of interest and income. Witness my signature this the ________________________________________ (date). __________________________________________ (Signature of Trustor) __________________________________________ (Printed Name of Trustor) STATE OF _______________________________________________ COUNTY OF ____________________________________ Personally appeared before me, the undersigned authority in and for the said county and state, on this _____ day of ______________________________________________, 20_____, within my jurisdiction, the within named ____________________________________________ (Name of Trustor), who acknowledged that he is Trustor in the Trust described in the above and foregoing instrument, and that in said representative capacity he executed the above and foregoing instrument, after first having been duly authorized so to do. ___________________________________ NOTARY PUBLIC My Commission Expires: ______________________ Acknowledgement of Receipt by Trustee The undersigned ________________________________________________________ (Name of Trustee), acknowledges that it is the Trustee in the Trust described above, and does hereby acknowledge receipt and acceptance of the terms of the above Revocation of Trust . Witness the signature of ____________________________________________________ (Name of Trustee) on this the _______________________________________________ (date). __________________________________________ (Name of Corporate Trustee) By: ______________________________________ __________________________________________ (Printed Name and Signature of Officer) STATE OF ________________________________________ COUNTY OF _________________________________ Personally appeared before me, the undersigned authority in and for the said County and State, on __________________________________________________ (date) , within my jurisdiction, the within-named ______________________________________________ (Name of Officer), who acknowledged that he is a (e.g., Vice-President and Trust Officer) ________________________________________________________ of ________________________________________________________ (Name of Trustee) , a ____________________________________________ (Name of State) corporation, and that for and on behalf of the said corporation, and as its act and deed, he executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. __________________________________________________ NOTARY PUBLIC My Commission Expires: ______________________ (Form of acknowledgements may vary from state to state)