Fill and Sign the Trustee Beneficiary Form

Release by Trustee to Beneficiary and Receipt from Beneficiary To: __________________________________________________________ (Name of Beneficiary), of ____________________________________________ __________________________________________________________________ _____________________________ (street address, city, county, state, zip code), Beneficiary under a Trust Agreement dated ______________________________ ______________ (date), between ______________________________________ ___________________________________ (Name of Trustor) , of ____________ __________________________________________________________________ __________________________________________________________________ (street address, city, county, state, zip code), as Trustor, and _________________ _______________________________________ (Name of Trustee) , of __________________________________________________________________ __________________________________________________________________ _____________________________ (street address, city, county, state, zip code), as Trustee: At your request and in discharge of my duties pursuant to the Trust described above, I, __________________________________________________________ (Name of Trustee) , release, surrender, assign, and set over, freely and absolutely to you all the estate, right, title, interest, use, benefit, privilege, and demand which I have or may have of or in any money or other property or thing contained, mentioned, or expressed in the above-referenced Trust Agreement. Neither I nor my successors or assigns shall at any time ask, claim, challenge, or demand any estate, right, title, interest, use, benefit, privilege, or other thing by reason or means of the trust agreement or any covenant contained in the Trust Agreement. All actions, suits, and demands which I or my successors or assigns may have concerning the Trust Agreement are excluded and forever barred. Witness my signature on this __________________________________________ ______________________ (date). ____________________________________ (Name of Corporate Trustee) By: ________________________________ ____________________________________ (Printed Name and Signature of Officer) STATE OF ___________________________________________ COUNTY OF ____________________________________ Personally appeared before me, the undersigned authority in and for the said County and State, on ________________________________________________ (date) , within my jurisdiction, the within-named ______________________________________ __________________________ (Name of Officer), who acknowledged that he is a (e.g., Vice-President and Trust Officer)____________________________________________ of ____________________________________________________________ (Name of Trustee) , a _______________________________________________ (Name of State) corporation, Trustee in the Trust Agreement described in the above and foregoing instrument, and that for and on behalf of the said corporation, and as its act and deed in the capacity as Trustee, he executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. ___________________________________________ NOTARY PUBLIC My Commission Expires: ______________________ Acknowledgement of Receipt by Beneficiary The undersigned ____________________________________________________ (Name of Beneficiary), acknowledges that he is the Beneficiary of the Trust described above, and does hereby acknowledge receipt and acceptance of the property held by _________________________________________________________________ (Name of Trustee) pursuant to the terms of the above said Trust Agreement.. Witness my signature on this the _______________________________________ _______________ (date). By: ________________________________ ____________________________________ (Printed Name & Signature of Beneficiary) STATE OF _______________________________________________ COUNTY OF __________________________________________ Personally appeared before me, the undersigned authority in and for the said County and State, on ________________________________________________ (date) , within my jurisdiction, the within-named ______________________________________ ________________________ (Name of Beneficiary), who acknowledged that he executed the above and foregoing instrument. ___________________________________________ NOTARY PUBLIC My Commission Expires: ______________________ (Form of acknowledgements may vary from state to state)