Fill and Sign the Testamentary Provisions Form

Testamentary Provisions for Charitable Remainder Annuity Trust for Term of Years I give, devise, and bequeath _____________________________________________ (description of property bequeathed) to my Trustee in trust to be administered under this provision. I intend this bequest to establish a charitable remainder annuity trust, within the meaning of Rev. Proc. 2003-58 and § 664(d)(1) of the Internal Revenue Code (the Code ). The Trust shall be known as the ________________________ (Name of Donor) Charitable Remainder Annuity Trust and I hereby designate ________________________ (Name of Trustee) as the Initial Trustee (the Trustee ). I. Payment of Annuity Amount. In each taxable year of the Trust during the annuity period, the Trustee shall pay to ________________________ (name of permissible recipient) (the Recipient ) an annuity amount equal to _______ % of the initial net fair market value of all property passing to this Trust as finally determined for federal estate tax purposes. The annuity period is a term of _____________ (number) years. The first day of the annuity period shall be the date of my death and the last day of the annuity period shall be the day preceding the __________________ (number of years) anniversary of that date. The annuity amount shall be paid in equal quarterly installments at the end of each calendar quarter from income, and to the extent income is not sufficient, from principal. Any income of the Trust for a taxable year in excess of the annuity amount shall be added to principal. If the initial net fair market value of the Trust assets is incorrectly determined, then within a reasonable period after the value is finally determined for federal estate tax purposes, the Trustee shall pay to the Recipient (in the case of an undervaluation) or receive from the Recipient (in the case of an overvaluation) an amount equal to the difference between the annuity amount(s) properly payable and the annuity amount(s) actually paid. II. Deferral Provision. The obligation to pay the annuity amount shall commence with the date of my death, but payment of the annuity amount may be deferred from this date until the end of the taxable year in which the Trust is completely funded. Within a reasonable time after the end of the taxable year in which the Trust is completely funded, the Trustee must pay to the Recipient (in the case of an underpayment) or receive from the Recipient (in the case of an overpayment) the difference between any annuity amounts actually paid, plus interest, and the annuity amounts payable, plus interest. The interest shall be computed for any period at the rate of interest, compounded annually, that the federal income tax regulations under 26 U.S.C.A. § 664 prescribe for this computation. III. Proration of Annuity Amount. The Trustee shall prorate the annuity amount on a daily basis for any short taxable year. In the taxable year of the Trust during which the annuity period ends, the Trustee shall prorate the annuity amount on a daily basis for the number of days of the annuity period in that taxable year. IV. Distribution to Charity. At the termination of the annuity period, the Trustee shall distribute all of the then principal and income of the Trust (other than any amount due the Recipient or the Recipient's estate under the provisions above) to ________________________ (name of designated remainderman) (the Charitable Organization ). If the Charitable Organization is not an organization described in 26 U.S.C.A. §§ 170(c) and 2055(a) at the time when any principal or income of the Trust is to be distributed to it, then the Trustee shall distribute the then principal and income to one or more organizations described in 26 U.S.C.A. §§ 170(c) and 2055(a) as the Trustee shall select, and in the proportions as the Trustee shall decide, in the Trustee's sole discretion. V. Addition Contributions. No additional contributions shall be made to the Trust after the initial contribution. The initial contribution, however, shall be deemed to consist of all property passing to the Trust by reason of my death. VI. Prohibited Transactions. The Trustee shall not engage in any act of self- dealing within the meaning of 26 U.S.C.A. § 4941(d), as modified by 26 U.S.C.A. § 4947(a)(2)(A), and shall not make any taxable expenditures within the meaning of 26 U.S.C.A. § 4945(d), as modified by 26 U.S.C.A. § 4947(a)(2)(A). VII. Taxable Year. The taxable year of the Trust shall be the calendar year. VIII. Governing Law. The operation of the Trust shall be governed by the laws of ____________________ (name of state) . However, the Trustee is prohibited from exercising any power or discretion granted under the laws of _____________________ (name of state) that would be inconsistent with the qualification of the Trust as a charitable remainder annuity Trust under 26 U.S.C.A. § 664(d)(1) and the corresponding regulations. IX. Limited Power of Amendment. This Trust is irrevocable. However, the Trustee shall have the power, acting alone, to amend the Trust from time-to-time in any manner required for the sole purpose of ensuring that the Trust qualifies and continues to qualify as a charitable remainder annuity Trust within the meaning of 26 U.S.C.A. § 664(d)(1). X. Investment of Trust Assets. Nothing in this Trust instrument shall be construed to restrict the Trustee from investing the Trust assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of Trust assets.