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Certificate of Trust

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CERTIFICATE OF TRUST

STATE OF ____________________
COUNTY OF ____________________

I. AFFIANT. I, ____________________ (“Affiant”), being duly sworn, deposes and


states under penalty of perjury that the foregoing is true and correct.

II. TRUST. The Trust is known as ____________________ (“Trust”).

The Trust has not been terminated, revoked, modified, or amended in any manner that
would cause the representations contained in this Certification of Trust to be incorrect.

a.) Type. The Trust is considered: (check one)


☐ - Revocable
☐ - Irrevocable
b.) Date. The Trust was signed on ____________________, 20_____.
c.) Tax ID Number. ____________________

III. SETTLOR(S). ____________________ (“Settlor(s)”) with a mailing address of


______________________________.

IV. TRUSTEE(S). ____________________ (“Trustee(s)”) with a mailing address of


______________________________.

V. SUCCESSOR TRUSTEE(S). ____________________ (“Successor Trustee(s)”) with


a mailing address of ______________________________.

VI. AUTHORITY. The authority to act on behalf of the Trust requires: (check one)

☐ - One (1) Trustee to sign.


☐ - ____ Trustee(s) to sign.

VII. POWERS. The Trustee(s) have: (check one)

☐ - Full powers to sell, convey and to mortgage or encumber real and personal
property under this Trust.
☐ - Limited powers to: ______________________________.

VIII. REAL ESTATE. The Trust includes: (check one)

☐ - No real estate.
☐ - Real estate with a legal description of: ______________________________.

IX. EXECUTION. I, the Affiant, declare that this certificate has been examined by me
and its contents are true and correct.

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Affiant’s Signature: _____________________________ Date: ______________

Print Name: _____________________________

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NOTARY ACKNOWLEDGEMENT
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.

State of ____________________
County of ____________________

On ____________________, 20____, before me, ____________________________


(insert name and title of the officer), personally appeared
____________________________, who proved to me on the basis of satisfactory
evidence to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or
the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of


____________________ that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature ____________________________. (Seal)

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