Fill and Sign the Tennessee Certificate Trust Form

Prepared By and After Recording Return to: ________________________________ ________________________________ ________________________________ ________________________________ ) ) ) ) ) ) ) ) ) ) ) -------- Above This Line Reserved For Official Use Only---------------- CERTIFICATE OF TRUST (Corporate Trustee(s)) STATE OF TENNESSEE 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(s) of each original trustee is/are: _____________________________________________________________________ _____________________________________________________________________; 4. The administrative or managerial powers of the Trustee(s) are: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 5. The Trust is Revocable Irrevocable. If revocable, the power to revoke the trust is held by: _______________________________________________________________. 6. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this certificate: Name _________________________ Address __________________________ 1 ___________________________ ___________________________ Name _________________________ Address __________________________ ___________________________ ___________________________ Name ________________________ Address __________________________ ___________________________ ___________________________ 7. a. No successor trustee(s) is named; or, b. The name and address of each successor trustee(s): Name _________________________ Address __________________________ ___________________________ ___________________________ Name _________________________ Address __________________________ ___________________________ ___________________________ Name ________________________ Address __________________________ ___________________________ ___________________________ 8. If multiple trustees, or multiple successor trustees are named, the number of trustees required to sign in order to exercise the powers of the trustee: All Majority Other, specify _____________________________________. 2 9. Successor trustees: a. Assume their position under the following conditions: _____________________________________________________________________. Or b. A third party may rely on the authority of one or more trustees without proof of their succession. 10. The Trust Identification No. is ____________________________________________. 11. Trust assets shall be titled as: _____________________________________________. 12. 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): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________; 13. The trust instrument has not been revoked, modified, or amended in any manner which would cause the representations contained herein to be 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. 13. 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. 3 Date: ___________________ Signature of Trustee _____________________________ Print Name ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ STATE OF TENNESSEE COUNTY OF __________________ Before me, _________________________________________ of the state and county mentioned, personally appeared _____________________________________, with whom I am personally acquainted, and who, upon oath, acknowledged such person to be president of _______________________________________________, the within named bargainor, a corporation, and that such president or officer as such __________________________________, executed the foregoing instrument for the purpose therein contained, by personally signing the name of the corporation as _________________________________. Witness my hand and seal, at office in ____________, this ________ day of 20_____. Notary Public ________________________ Printed Name: _______________________ My Commission Expires: _____________________ 4 STATE OF TENNESSEE COUNTY OF __________________ Before me, _________________________________________ of the state and county mentioned, personally appeared _____________________________________, with whom I am personally acquainted, and who, upon oath, acknowledged such person to be president of _______________________________________________, the within named bargainor, a corporation, and that such president or officer as such __________________________________, executed the foregoing instrument for the purpose therein contained, by personally signing the name of the corporation as _________________________________. Witness my hand and seal, at office in ____________, this ________ day of 20_____. Notary Public ________________________ Printed Name: _______________________ My Commission Expires: _____________________ STATE OF TENNESSEE COUNTY OF __________________ Before me, _________________________________________ of the state and county mentioned, personally appeared _____________________________________, with whom I am personally acquainted, and who, upon oath, acknowledged such person to be president of _______________________________________________, the within named bargainor, a corporation, and that such president or officer as such __________________________________, executed the foregoing instrument for the purpose therein contained, by personally signing the name of the corporation as _________________________________. Witness my hand and seal, at office in ____________, this ________ day of 20_____. Notary Public ________________________ Printed Name: _______________________ My Commission Expires: 5 _____________________ 6