Fill and Sign the Tennessee Trust 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 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 __________________________ 2 ___________________________ ___________________________ 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 _____________________________________. 3 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. 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. 4 Date: ___________________ Signature of Trustee _____________________________Print Name ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ Signature of Trustee _____________________________ Print Name ____________________________________ STATE OF TENNESSEE COUNTY OF __________________ On this ______ day of ______________, 20 ____, before me personally appeared _____________________________________________, to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that such person(s) executed the same as such person (‘s) free act and deed. Notary Public ___________________________ Printed Name: __________________________ Commission Expires: _________________ STATE OF TENNESSEE COUNTY OF __________________ On this ______ day of ______________, 20 ____, before me personally appeared _____________________________________________, to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that such person(s) executed the same as such person (‘s) free act and deed. Notary Public ___________________________ Printed Name: __________________________ Commission Expires: _________________ 5 STATE OF TENNESSEE COUNTY OF __________________ On this ______ day of ______________, 20 ____, before me personally appeared _____________________________________________, to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that such person(s) executed the same as such person (‘s) free act and deed. Notary Public ___________________________ Printed Name: __________________________ Commission Expires: _________________