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Amendment to Trust Agreement in Order to Change Beneficiaries I, ____________________________________________________ (Name of Trustor), of _____________________________________________________________ ________________________________________________________________________ ___________________________________ (street address, city, county, state, zip code), am the Trustor under a Trust Agreement dated __________________________________ (date), by which I assigned, transferred, and delivered to __________________________ _____________________________ (Name of Trustee) certain property, in trust for the benefit of ____________________________________________ ( Name of Beneficiary) , for the uses and purposes specified in the Agreement. Pursuant to this Trust Agreement I reserved the power to change the beneficiary of this Trust. Pursuant to this power, I hereby amend the Trust Agreement by striking out the name of _____________________ ___________________________________ ( Name of Beneficiary) wherever it appears in the Agreement and by substituting in its place the name of ______________________ _________________________________ (Name of New Beneficiary) , of ____________ ________________________________________________________________________ ________________________________________________________________________ ___________________________________ (street address, city, county, state, zip code). In all other respects I ratify and confirm the provisions of the Trust Agreement. Witness my signature __________________________________________ (date). ___________________________________ ____________________________________ (Printed Name and Signature of Trustor) STATE OF ____________________________________________ 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 Trustor), who acknowledged that he/she is the Trustor under a trust agreement dated _________________________________________ (date), originally for the benefit of ___________________________________________ ( Name of Beneficiary) , and that in said representative capacity he/she executed the above and foregoing instrument, after first having been duly authorized so to do. ____________________________________ NOTARY PUBLIC My Commission Expires: ______________________ (Form of acknowledgement may vary from state to state)

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