Declaration Of Life Insurance Trust Form Page 3

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No Trustee of the trust created by this agreement shall at any time be held liable for any
action or default of himself, or of his agent, or of any other person in connection with the
administration and management of this trust unless caused by this own gross negligence or by
commission of a willful act of breach of trust.
XII.
The Trustee, by joining in the execution of this agreement, hereby signifies his
acceptance of this trust.
XIII.
The Trustee shall have sole authority to determine what shall be defined as income and
what shall be defined as principal of the trust established by this agreement, and to determine
which costs, taxes and other expenses shall be paid out of income and which shall be paid of out
principal.
XIV.
In the event that any portion of this agreement of the trust created hereby shall be held
illegal, invalid or otherwise inoperative, it is my intention that all of the other provisions hereof
shall continue to be fully effective and operative insofar as is possible and reasonable.
IN WITNESS WHEREOF, the parties hereto have executed this agreement the day and
year first above written.
__________(9)__________
__________(10)__________
Trustier
__________(9)__________
__________(9)__________
__________(11)___________
__________(9)__________
STATE OF ___________(12)____________)
COUNTY OF __________(13)___________)
On this ________(14)________ day of ______(15)______, ________(16)_______,
before me personally came and appeared ______(17)______, known, and known to me, to be
the individuals described in and who executed the foregoing instrument, and who duly
acknowledged to me that he executed same for the purpose therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
___________(18)___________
My Commission Expires:______(19)_____
NOTICE
The information in this document is designed to provide an outline that you can follow
when formulating business or personal plans. Due to the variances of many local, city, county

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