Fill and Sign the Trust Certificate Form

Certificate or Memorandum of Trust Agreement ________________________ (Name of Trustee), the undersigned Trustee, being first duly sworn, certifies that a Trust exists and states: 1. Title of Trust The name of the Trust is: _________________________ (Name of Trust). 2. Date of Trust The date of the Trust is: ____________________ (Date of Trust). 3. Trust Tax Identification Number The Trust tax identification number is: ___________________________ (TIN). 4. Trustee The name and address of the Trustee currently acting for the Trust is: ________________________ (Name of Trustee), _____________________________ __________________________________________ (address of Trustee) 5. Powers of Trustee A. The Trustee may buy, sell and trade securities of any nature, including short sales, on margin, and for such purposes may maintain and operate margin accounts with brokers, and may pledge any securities held or purchased by it with such brokers as security for loans and advances made to the Trustee. B. The Trustee has power to sell, exchange, lease, give options for, transfer and/or convey real property, including the power to execute all necessary documents. C. These powers are in extension and not in limitation of the powers conferred by _______________________________ (citation to relevant state statute) , as amended, or any corresponding similar statute. 6. Governing Law The Trust Agreement, and any amendment, is governed by the laws of _____________(name of state) . 7. Full Force and Effect The Trust Agreement, and any amendment, remains in full force and effect. 8. Reliance This Certificate of Trust correctly cites the current status of the Trust Agreement. Witness my signature this the _____ day of _______________, 20_____. _____________________________ (Printed Name of Trustee) _____________________________ (Signature of Trustee) (Acknowledgment form may vary by state) State ______________ 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 Trustee),as Trustee under the ____________________ (Name of Trust) , who acknowledged that he executed the above and foregoing instrument as Trustee and as his act and deed. _________________________ NOTARY PUBLIC My Commission expires: ___________________