Declaration Of Life Insurance Trust Form

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DECLARATION OF LIFE INSURANCE TRUST
This Declaration of Insurance Trust is made this _________(1)_______ day of _______
(2)_______, ________(3)________, by and between _________(4)__________, of __________
(5)_________, hereinafter called the Trustier, and _________(6)________, of _________(7)
__________, hereinafter called the Trustee.
I.
The Trustier, as owner of certain life insurance policy or policies listed below, and
desiring to establish a Life Insurance Trust, with power in the Trustee upon the death of the
Trustier to purchase assets from Trustor's estate, assigns to the Trustee all his right, title, and
interest in the policy or policies of insurance, to be held by Trustee in trust, and to receive the
proceeds of the policy or policies of insurance when they become due and are paid, for the
purposes and on the conditions set forth herein. The Trustier reserves the right to add to this trust
from time to time additional life insurance policies which, when delivered to the Trustee, shall be
held by him subject to the terms herein.
(Description of Life Insurance policies)
II.
The Trustee is vested with all right, title, and interest in the life insurance policy or
policies, and is authorized and empowered to exercise and enjoy, for the purposes of the trust
and as absolute owner of the policy of insurance, all the options, benefits, rights, and privileges
under the policy or policies. The Trustier relinquishes all rights and powers in the life insurance
policy or policies which are not assignable and will, at the request of the Trustee, execute all
other instruments reasonably required to effectuate this relinquishment. The trustee shall
receive and hold said Life Insurance policies, together with any additions thereto, in trust for the
use and benefit of:
(List names of Beneficiaries)
III.
Upon the death of the Trustor, the Trustee may, within his discretion, purchase assets
from Trustor's estate at a fair value. The propriety of the purchase, the amount of such assets
purchased, and the ascertainment of fair value shall be solely within the discretion of the Trustee,
and the Trustee shall incur no liability as a result of the purchase or purchases whether or not the
assets constitute investments which may be legally made by Trustee.
IV.
If the Trustee uses all or any portion of the proceeds of the policy of insurance to
purchase assets from the estate of the Trustor, as authorized above, then the net income
produced from the assets, or the proceeds of any sale, exchange, or reinvestment of the assets,
shall be paid to the spouse of the Trustier during the spouse’s lifetime.
V.
If any beneficiary of this trust who is at the time receiving income would otherwise, in the
opinion of the Trustee, be subject to hardship or suffering, the Trustee shall have the authority to
pay over and distribute, at any time and from time to time, to the beneficiary the amounts of the
principal of this trust, from which the beneficiary shall then be entitled to receive income as the
Trustee, in his sole discretion, shall deem necessary to provide for the maintenance, comfort,
support, and medical care of the beneficiary.

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