Fill and Sign the Revocation Trust Form

Partial Revocation of Trust and Acknowledgment of Receipt of Notice of Partial 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, pursuant to the right reserved to me as Trustor under Section __________________ of the Trust, I do hereby elect to revoke the Trust as to the property hereinafter described, but only as to the hereinafter described property, to wit: (Set Forth Description of Property) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I hereby direct that you transfer and deliver all your right, title, and interest in and to that property to me. 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 Partial 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)