Fill and Sign the Trust Account Form

Irrevocable Funeral Trust -- Prearranged Funeral Trust Account Account No.: ________________________ (account number) The undersigned _______________________ (Name of Trust or) , hereinafter called Trustor , do hereby open individual Trustee savings account, No. __________________ (Account number) , in _____________________________ (Name of Bank) , located at ____________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter referred to as the Bank, as Trustee for ______________________ (name of funeral director) , of __________________________ _____________________________________ (street address, city, county, state, zip code) , hereinafter referred to as the Beneficiary. 1. Authority of Bank A. Bank is authorized to act without further inquiry in accordance with writings bearing my signature as contained below. B. Bank is authorized to supply any endorsement for Trustee on any check or other instrument tendered for this account. C. Bank is relieved of any liability in connection with collection of the items that it handles without negligence. D. Bank shall not be liable for the acts of its agents, subagents, or others or for any casualty. 2. Withdrawals Withdrawals may not be made from the Account during the lifetime of Trustor. Any expenses incurred relative to this Account may be charged to it. 3. Trustor agrees to be bound by and subject to the bylaws of Bank with respect to all resolutions, regulations, amendments, and rules in practice now or subsequently adopted with respect to deposits. 4. Funds for Beneficiary The funds in the Account, together with earnings on the funds, and any future additions to the funds are conveyed for the benefit of the Beneficiary. 5. Conditions of Trust The conditions of the Trust are: A. Bank is authorized to hold, manage, invest, and reinvest the funds in its sole discretion. B. The Trust is irrevocable. C. In the event of the resignation or removal of Trustee, ____________________ (name of first successor trustee) is appointed successor Trustee. In the event of the resignation or removal of successor Trustee, _______________________ ( name of second successor trustee) is appointed successor Trustee. 6. Personal Information regarding Trustor My Social Security Number is _______________ ( social security number of Trustor) . My date of birth is _________________ (date of birth of Trustor) . WITNESS my signature this the _______day of _______________, 20______. _________________________ (P rinted Name of Trustor) _________________________ (Signature of Trustor)