Certification Of Trust By Trustee(S) Form
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1CERTIFICATION OF TRUST BY TRUSTEE(S)
Date:____________________________
Account Number:__________________
The undersigned declares:
1. Settlors/trustors (names):__________________________________________________________________
________________________________________________________________________________________
Established a trust titled:____________________________________________________________________
________________________________________________________________________________________
By written declaration of trust dated:__________________________________________________________
2. The current acting trustee/trustees of the trust is/are:______________________________________________
_________________________________________________________________________________________
NOTE: Title to assets of the trust will be taken as designated above.
3. The tax identification number of the trust is:_____________________________________________________
4. The type of above trust is:
Revocable Living Trust
Irrevocable Trust
Testamentary Trust
Other:____________________________________________________________
NOTE: (if trust is revocable, please indicate in the space provided on signature page which trustee(s) have the power to revoke)
5. The powers of the trustee(s) include:
Buying and selling securities (including stocks, bonds, mutual funds and government obligations)
Buying and selling options
Maintaining a margin account
Utilizing check writing features for securities account
6. While all statements and disbursements on behalf of the trust are to be issued in the name of the trust as provided in
paragraphs 1 and 2 above, please indicate who may give the above direction:
Third party may follow the instructions of any one (1) trustee
Other (specify) _____________________________________________________________________________
7. The successor trustees are: _____________________________________________________________________
_____________________________________________________________________________________________
8. This trust has not been revoked, modified or amended in any manner which would cause the representations contained in this
Certification to be incorrect.
9. This Certification is signed by all of the currently acting Trustees of the trust. I/we agree to immediately inform you, in
writing, of any amendments to or revocation of the trust, any change in the composition of the trust, or any other event that
would alter the certifications made above.
All trustees must sign below:
Signature of Trustee:___________________ ____
Signature of Trustee:_________________________
Print name:_______________________________
Print Name:________________________________
Address:_________________________________
Address:___________________________________
________________________________________
__________________________________________
Signature of Trustee:_______________________
Signature of Trustee:__________________________
Print name:_______________________________
Print Name:_________________________________
Address:_________________________________
Address:____________________________________
________________________________________
___________________________________________
01/09
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