Stock Will Form - B/w
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1STOCK WILL
FORM
TESTAMENTARY DISPOSITION
NANA Regional Corporation, Inc., Attn: Shareholder Records, PO Box 49, Kotzebue, AK 99752
For assistance, call (907) 442-3301 or (800) 478-3301. Fax: (907) 343-5758
INHERITORS
UPON MY DEATH, I give, devise, and bequeath my NANA Regional Corporation, Inc. shares to the following
person(s) in the amount(s) set forth:
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
Number of Shares to be Given
Address
City
State
Zip
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
Number of Shares to be Given
Address
City
State
Zip
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
Number of Shares to be Given
Address
City
State
Zip
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
Number of Shares to be Given
Address
City
State
Zip
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
Number of Shares to be Given
Address
City
State
Zip
If any of the above persons is/are under the age of 18 when I die, I name the following person(s) as the custodian
for their shares: _____________________________________________________________________________
__________________________________________________________________________________________
This Testamentary Disposition is made under the provisions of Alaska Statutes 13.16.705 and Section 7(h)(2) of the
Alaska Native Claims Settlement Act of 1971, 85 Stat. 688.
CERTIFICATION
I certify that the information given in this application is true to the best of my knowledge and belief.
Last Name
First Name
Middle Initial
Suffix (Sr./Jr.)
DOB: month/day/year
/
/
Signature
Date
SUBSCRIBED AND SWORN BEFORE ME THIS
____________________ DAY OF ________ 20
Notary Public __________________________________ My Commission Expires ______________________
2015 - 10/28
F-19
Stock Will Form | Page 1 of 1
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