Form Char001 - Trusts And Estates Registration Form Page 2

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PA RT II:
COMPLETE ALL ITEMS OF THIS PART
A) Describe and list book value of assets and liabilities (at date of death ) belo w o r on an attached she et.
Asse ts
Book Value
Liabilities
Book Value
$
$
$
$
$
$
$
$
$
$
Total A ssets:
$
Total Liabilities:
$
B) List na me (s) and address(es) of ban k depositories an d acc oun t num bers b elow or on an attached she et.
Bank Name
Ban k Ad dress
Account Num ber
C) Has an application been m ade to the Internal R evenue Serv ice for tax ex empt status? . . . . . . . . . .
Yes
No
If yes, has determination letter been issued? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
*
Attach copy of IRS determination letter if issued.
D) List names, addresses and titles of all trustees, executors or administrators (whichever is applicable).
Name
Title
Address
FORM PREPARED BY:
Signature
Printed Name
Title
Date
Street Address:
City:
State:
Zip:
Daytim e Phone :
Fax:
Em ail Ad dress:
CHAR001 (Rev. 10/02)

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