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DEED OF TRUST 



This Deed of Trust (the Agreement) is effective [DATE],


BETWEEN:  [DONOR NAME] (the "Donor"), an individual with his main address located at:

      [YOUR COMPLETE ADDRESS]

AND:  [FIRST TRUSTEE NAME] (the "First Trustee"), an individual with his main address located at:

      [COMPLETE ADDRESS]

AND:  [SECOND TRUSTEE NAME] (the "Second Trustee"), an individual with his main address located at:

      [COMPLETE ADDRESS]


WHEREAS the Donor desires to make provision for the welfare and benefit of the persons named in sub-paragraph 3.3 of Article 3 and for this purpose has determined to constitute a trust patrimony and appoint the parties hereto of THE SECOND PART and their successors as Trustees to receive the Trust Property hereinafter mentioned, to be held by them in trust and administered as hereinafter set forth;

AND WHEREAS the Trustees have agreed to act as Trustees under the terms hereof and to hold the said property and any other monies, securities, property and assets, forming part of the Trust Property on and subject to the Trust hereinafter declared;

NOW THEREFORE THIS INDENTURE WITNESSETH:


ARTICLE 1

1.1  The Donor by these presents constitutes a trust patrimony to be known by the name set out in Article 12 (herein referred to as the Trust) and appropriates, transfers and delivers as an irrevocable donation inter vivos unto the Trustees the sum of [AMOUNT] in trust for the welfare and benefit of the Beneficiaries named in sub-paragraph 3.3 of Article 3 as hereinafter set forth which property the Trustees acknowledge to have received at the execution hereof and accept for the benefit of the Beneficiaries.

1.2  The Trustees agree to administer the sum of [AMOUNT] and any additional property of any nature and kind which such trust patrimony may acquire as part of the Trust Property for the purposes and upon the terms and conditions herein set forth.

ARTICLE 2

2.1  The Trust Property shall be held, administered, dealt with and disposed of by the Trustees in trust, upon the trust and for the purposes hereinafter set forth (for the benefit of the Beneficiaries).

2.2  The Trustees shall invest and keep invested the Trust Property in the manner as hereinafter set forth. Until the Final Distribution Date, the Trustees may, in their absolute and unfettered discretion, pay any amount or amounts out of the Net Annual Income derived from the Trust Property to or for the benefit of anyone or more of the Beneficiaries at such time or times, in such proportion or proportions, and in such manner as the Trustees, in their absolute and unfettered discretion, shall determine. In making any such payments of the Net Annual Income, the Trustees may, in their absolute and unfettered discretion, completely exclude any one or more of the Beneficiaries. The Trustees shall accumulate any amount or amounts of the Net Annual Income derived from the Trust Property and not paid over to or for the benefit of any one or more of the Beneficiaries and shall add such amount or amounts of the Net Annual Income derived from the Trust Property and not paid to or for the benefit of any one or more of the Beneficiaries to the capital of the Trust Property.

2.3  In addition to the payments of income, the Trustees may, in their uncontrolled discretion, pay, from time to time, out of the capital of the Trust Property, such amount or amounts as the Trustees may consider advisable for the care, comfort, support, maintenance, general welfare, basic or advanced education, business or professional requirements, investment opportunities or expenses and any accident, sickness or emergency of or affecting any of such Beneficiaries.

2.4  The capital of the Trust Property, including any amounts which may have become capitalized in the manner set forth hereinafter, shall be distributed by the Trustees on the Final Distribution Date to or for the benefit of any one or more of the Beneficiaries in such proportion or proportions and in such manner as the Trustees, in their absolute and unfettered discretion, shall determine and the Trustees shall thereupon be and become finally released and discharged hereunder; when so paying or transferring the whole of the Trust Property then remaining in their hands, the Trustees may, in their absolute and unfettered discretion, completely exclude any one or more of the Beneficiaries.


ARTICLE 3

In this deed where the context so admits the following expressions bear the following respective meanings, that is to say:

3.1  the Trustees mean the Trustees named herein or any other Trustee or Trustees validly appointed as a replacement thereof;

3.2  the Trust Property shall consist of and mean the said sum of [AMOUNT] delivered to the Trustees as aforesaid together with all amounts accumulated by the Trustees and such additional property and assets, real or personal, moveable or immoveable, which the Donor and/or any other person or persons, company or companies, trust or trusts may at any time and from time to time with the approval of the Trustees pay, transfer, lend, assign or convey into the name or under the legal control of the Trustees to be held upon the Trust herein contained or which may at any time hereafter in any other manner become subject to the Trust hereof and shall include any and all property and assets, real or personal, in which the same may be invested by the Trustees or into which the same may be converted by the Trustees, at any time or from time to time, as well as any additions or accretions thereto;

3.3  Beneficiaries mean and include the following persons, that is to say:

3.3.1  [Son/Daughter] of the Donor, with representation, per stirpes, in favor of the issue of [Son/Daughter/Wife/Husband] in the event that Donor dies during the term of this Trust (and in the latter case, the issue of [Son/Daughter/Wife/Husband] shall for the purposes hereof be deemed to be a single Beneficiary);

3.3.2  [Son/Daughter] of the Donor, with representation, per stirpes, in favor of the issue of [Son/Daughter/Wife/Husband] in the event that Donor dies during the term of this Trust (and in the latter case, the issue of [Son/Daughter/Wife/Husband] shall for the purposes hereof be deemed to be a single Beneficiary);
3.3.3  wife of the Donor;

3.3.4  the Donor; and

3.3.5  in the event that none of the Beneficiaries described in sub-paragraphs (i), (ii)., (iii) and (iv) hereinabove are alive on the Final Distribution Date, such charity or charities and/or research fund or research funds as the Trustees may in their absolute and uncontrolled discretion decide provided, however, that each such charity shall then be a registered charity within the meaning of the Income Tax Act, [COUNTRY];

3.4  Net Annual Income means, for any particular fiscal period of the trust,

3.4.1  all of the income derived from the Trust Property less the aggregate of           
3.4.2  any and all expenses incurred or payable in respect of or to protect the Trust Property or incurred or payable in connection with the management and administration of the Trust herein contained, as determined by the Trustees to be chargeable to income,

3.4.3  such further or other sums in each year as the Trustees in their absolute and uncontrolled discretion consider to be proper allowances, reserves, deductions, disbursements, or outgoings in accordance with generally accepted accounting principles, and

3.4.4  without limiting the generality of the foregoing, such sums in each year as the Trustees shall in their absolute and uncontrolled discretion consider necessary and advisable from time to time as being on account of depletion, deterioration or obsolescence of any of the assets of the Trust Property.

3.5  The terms income and capital herein shall be interpreted in accordance with generally accepted accounting principles and without reference to the provisions of the Income Tax Act, [COUNTRY] or the Taxation Act, [STATE/PROVINCE].

3.6  Income Tax Act, [COUNTRY] or any reference to a specific provision or specific provisions thereof shall mean the Income Tax Act, as amended, or such provision or provisions, as the case may be, as amended from time to time, of any legislation of the Parliament of [COUNTRY] from time to time in force of like or similar effect, and Taxation Act, [STATE/PROVINCE] or any reference to a specific provision or specific provisions thereof shall mean the Taxation Act, [STATE/PROVINCE], , as amended. 

3.7  Final Distribution Date means the [NUMBER] anniversary of the date of execution of the present Deed less a day.

ARTICLE 4

4.1  Without in any way limiting or derogating from the powers, authorities, discretions and immunities otherwise howsoever available to the Trustees, whether under any statute of [COUNTRY] law or otherwise, the Trustees hereunder shall have and be vested with the following powers, authorities, discretions, and immunities, and as to which their judgment shall be final and conclusive upon all interested parties, and no person dealing with them shall be charged with any duty to enquire into the propriety of their action, that is to say:

4.1.1  to invest or re-invest the Trust Property and sell (whether by public or private sale or with or without notice, for cash or on credit, or partly for cash and partly on credit), assign, transfer, exchange, convey, lease, hypothecate, mortgage or otherwise dispose of or encumber the Trust Property or any part thereof at any time or from time to time as the Trustees in their absolute discretion may deem advisable, and at such price or prices and on such terms as they may consider advisable, which terms may extend beyond the duration of the Trust hereby created, and to grant discharges therefore;

4.1.2  to make or retain any investment or investments that they consider advisable notwithstanding that such investments may not be in the form of investments in which Trustees are authorized to invest trust funds under the laws of the [State/Province] of [STATE/PROVINCE] or any jurisdiction of [COUNTRY], and the Trustees shall not be responsible for any loss which may be occasioned by reason of the making of such investments or the retention of the same;

4.1.3  notwithstanding anything herein elsewhere contained or any rule of law to the contrary, to receive, purchase and acquire, at any time and from time to time, as an investment, and to hold as part of the Trust Property, any shares, securities or property, immovable, movable, real, personal or mixed, owned by the Donor, or owned by the Donors estate after death, or owned by any other person or company or corporation, at such price or prices and upon such terms as may be deemed desirable or expedient by the Trustees, and the decision of the Trustees in this regard shall be final, absolute and binding;

4.1.4  to retain any life insurance policy entrusted to them or from time to time held by them hereunder; to accept as assignee, for a consideration or as a donation to form part of the Trust Property, any life insurance policy or policies and/or benefit or benefits under such policy or policies; to purchase insurance on the life of any one or more of the Beneficiaries hereunder; to purchase insurance on the life of anyone in whom such Beneficiary or Beneficiaries has an insurable interest and to select such type of policy and mode of premium payments as they may deem advisable; to pay premiums on such policies either out of capital or out of income or partly out of capital and partly out of income as they shall deem proper. All such insurance and policy or policies shall be payable to the Trustees hereunder and shall be held as part of the Trust Property, and the proceeds thereof, when received by the Trustees, shall form part of the Trust Property. He Trustees shall have full power and authority to borrow money on the security of any policy or policies, to sell any such policy or policies or surrender the same and to accept in exchange therefore, or in lieu thereof, any different policy or policies and generally in respect of the said policy or policies the Trustees shall have all the powers of an absolute owner thereof for the purpose of dealing with the same in such manner as they shall consider in the best interests of any one or more of the Beneficiaries hereunder;

4.1.5  to purchase annuities for any one or more of the Beneficiaries and to select such type of annuity and mode of payment therefore as they may deem advisable; and to purchase and pay the premiums on policies of insurance against fire, other casualty or public liability or other insurance of a similar character, but they shall not be liable for any omission to purchase any insurance or to purchase a particular amount of any type of insurance;

4.1.6  to vote all shares and stocks forming part of the Trust Property, and to exercise all rights incidental to the ownership of shares, stocks, bonds, debentures or other securities or investments forming part of the Trust Property and to issue proxies therefore to others and to vote for the election of themselves or of any one or more of themselves to any executive or to the board or committee of any such company or corporation or association, and to serve in any such office or on any such board or committee and accept and receive remuneration for such services; to sell or exercise any subscription rights and in connection with the exercise of subscription rights to use any portion of the Trust Property for such purpose; to consent to and join in any plan for reconstruction, reorganization, amalgamation, consolidation or readjustment in respect of any company or corporation whose shares, stocks, bonds, debentures or other securities for the time being form part of the Trust Property or for the sale of the assets and undertaking, or a substantial portion thereof, of any such company or corporation, and in pursuance of any such plan to accept any shares, stocks, bonds, debentures or other securities in exchange for the shares, stocks, bonds, debentures or other securities then forming part of the Trust Property; to join in any shareholder agreement or unanimous shareholder agreement in respect of the capital stock of a corporation of which it holds shares of any class; and generally to act in respect of any securities or investments forming part of the Trust Property as fully and effectually as if the same were not Trust Property but always in such manner as the Trustees shall in their uncontrolled discretion consider to be in the best interests of the Beneficiaries hereunder;

4.1.7  to appoint one of their number or some person or persons their proxy to vote such shares and stocks;

4.1.8  to enter into partnership and/or limited partnership arrangements;

4.1.9  to manage immovable or real or leasehold property entrusted to them or from time to time held by them hereunder and to make such ordinary and extraordinary repairs and such alterations and improvements thereon as they shall deem advisable; to raze buildings and erect new buildings; to subdivide and plot immovable or real property, to lay out and dedicate ways, roads and public places, to grant or release servitudes or easements and to enter into partition, common wall and boundary line agreements and agreements of any other kind with respect to immovable or real property; to make any payment for such repairs, alterations and improvements or services or in connection with such management out of capital or out of income or partly out of capital and partly out of income, as they shall deem proper; to renew and hold renewed any hypothec or hypothecs, mortgage or mortgages, and to borrow monies for refunding any hypothec or hypothecs, mortgage or mortgages; and generally to manage any such immovable or real or leasehold property;

4.1.10  to lease at any time and from time to time real property or any interest in immovable or real property entrusted to them or from time to time held by them hereunder for such term or terms of months or years, to begin presently or in the future, as to them may seem proper, even though such lease or leases shall be for a term or terms beyond the time of the termination of any trust estate herein created, such leases to be with such options to the lessees of renewal and/or purchase or for the purchase or disposal of buildings thereon or to be placed thereon, and upon such covenants, terms, conditions, agreements and provisions as to them shall seem proper; and in connection therewith to make, execute, acknowledge and deliver any and all instruments that may be necessary, proper and desirable;

4.1.11  to lend the Trust Property or any part thereof for any security, which they in their absolute discretion may deem sufficient, or upon any security whatsoever and to give complete and valid discharge therefore;

4.1.12  to determine whether any dividend or dividends received or distributed by the Trustees, shall constitute income or capital and the decision of the Trustees shall be final and binding upon the Beneficiaries hereof;

4.1.13  to incorporate any company or companies under the laws of [COUNTRY] or the [State/Province] of [STATE/PROVINCE], or any other jurisdiction in [COUNTRY] or elsewhere, at the expense of the Trust Property for the purpose of investing the whole or any part of the Trust Property wholly or partly in shares or other securities of such company or companies or corporation or corporations;

4.1.14  to waive or agree to waive, in whole or in part, unpaid accrued interest, or accumulated dividends of any investment which may be held by them at any time, or to release any person, firm, company or corporation from any obligation to the Trust, with or without compensation therefore;

4.1.15  to execute and deliver agreements, assignments, bills of sale, contracts, deeds, notes, powers of attorney, receipts, and any and all other instruments in writing necessary or appropriate in the opinion of the Trustees for the settlement or administration of the Trust, and to execute any such instrument without warranty by or without recourse to the Trustees;

4.1.16  to open and operate such bank account or bank accounts as may be expedient in the opinion of the Trustees and to deposit any cash balances in the hands of the Trustees at any time in any chartered bank or trust company, and, for the purposes of the Trust, to draw, make, endorse, deposit, or deal in checks, bills of exchange, promissory notes, drafts, or any other mercantile, commercial or security documents of any nature or kind, and to enter into contracts or agreements of any nature or kind, with such bank or trust company, and for such purposes the signature of the Trustee or those Trustees designated by all of the Trustees in writing, as Trustees, and not in their personal capacity, shall be valid and binding upon the Trust, and all such forms as may be required to open bank accounts, operate same and related matters, shall be completed in the required manner and on the forms required by such bank or trust company account, and to designate any Trustee or Trustees or any other person or persons as the signing authority for any such bank account or accounts or trust company account or accounts opened by the Trustees;

4.1.17  to employ and compensate agents, accountants, notaries, lawyers, brokers and other assistants and advisers deemed by them to be helpful, for the proper settlement or administration of the within Trust, and to do so without any liability for any neglect, omission, misconduct, or default of any such employed person, provided he was selected and retained with reasonable care;

4.1.18  to institute, prosecute and defend any suits or actions or other proceedings affecting them or the Trust Property or any part thereof, to compromise or settle any matter of difference or to submit any such matters to arbitration, to compromise or compound any debts owing to or by the Trust upon evidence that to them shall seem sufficient; to make partition in whole or in part at public auction or private sale or otherwise and upon such terms as they deem advisable with any co-owners or joint owners having any interest in any properties comprised in the Trust Property and to make such partition either by sale or by set-off or by agreement or otherwise;

4.1.19  to enter into guarantees or indemnifications for the benefit of any one or more of the Beneficiaries and persons, firms companies, or corporations other than the Beneficiaries and to give security therefore as the Trustees may in their discretion decide;

4.1.20  to hold the Trust Property or any part or parts thereof at any place or places and to move the same from time to time from place to place inside or outside [COUNTRY] and notwithstanding any of the trusts, powers and provisions herein contained the Trustees may in their absolute discretion at any time or times transfer and convey the whole or any share or portion of the Trust Property or of any of the property from time to time forming part of the Trust Property, to any other trust or settlement whether established under or pursuant to the law of [STATE/PROVINCE], or any other jurisdiction whatsoever, to be held by the trustee(s) of such other trust or settlement with and subject to the powers and provisions of such other trust or settlement provided that the any one or more of the Beneficiaries of this trust shall be any one or more of the Beneficiaries of such other trust or settlement and the respective interests and rights of any one or more of the Beneficiaries in and with respect to such share or portion of the Trust Property or such property so transferred and conveyed under such other trust or settlement shall be the same as or substantially the same as, where possible under the laws of such jurisdiction, the interests and rights of any one or more of the Beneficiaries in and with respect to the Trust Property under this settlement.

4.2  The Trustees shall have power and authority to make any payments hereunder, for so long as any of the Beneficiaries are not of the full age of majority under the laws of his/her domicile, to the parent or tutor or guardian or individual having the custody or control of any such person, whose receipt shall be a sufficient discharge to the Trustees, who shall not be bound to see to the application of any monies so paid.

4.3  The Trustees may make any payments, provisions, apportionments, or distributions which may be required under the terms of this Trust in whole or in part in monies, securities or other property comprising the Trust Property, and every apportionment and distribution, and valuation therefore, which in the discretion of the Trustees shall seem equitable, shall be final, conclusive and binding upon all persons interested hereunder.

The Trustees may, in their uncontrolled discretion, borrow money on security or without security from time to time for any purpose that they deem advisable and upon such terms and conditions as they may deem advisable, and as security therefore they may mortgage, hypothecate, or otherwise charge the Trust Property or any part thereof, and may make, execute and deliver under seal or otherwise such notes, bonds, hypothecs, mortgages, or other obligations as may be required.

4.5  The Trustees may in their absolute discretion determine in the case of investments purchased or sold at a premium or discount or in the case of any monies received, whether such premium, discount or amount received shall be credited to or charged against capital or income; and shall further determine, in their absolute discretion, in case of receipt of stock dividends or stock holders subscription rights from stocks held as Trust Property whether such stock dividends, subscription rights or the proceeds thereof, in case the same should be sold, shall be credited to capital or income.

4.6  The Trustees may make, or refrain from making, in their absolute discretion, any election or elections, any determination or determinations, and any designation or designations permitted by any statute or statutes or regulation or regulations enacted by the Parliament or government of the Dominion of [COUNTRY], by the legislature or government of any [State/Province] of [STATE/PROVINCE], or by any other legislative or governmental body of any other country, state/province, state or territory, and such exercise of discretion by the Trustees shall be conclusive and binding upon the Beneficiaries hereof. The Trustees may, in addition, when they consider that it is in the interest of any of the Beneficiaries who qualify as a preferred beneficiary pursuant to the relevant provisions of the Income Tax Act, [COUNTRY] and the Taxation Act, [STATE/PROVINCE], elect on behalf and in the name of such Beneficiary in respect of a taxation year that such part of the accumulating Net Annual Income derived from the Trust Property for the year as is designated in the election, not exceeding such Beneficiarys share therein, shall be included in computing the income of that Beneficiary for the year and shall not be included in computing the income of such Beneficiary for a subsequent year in which it is paid.


ARTICLE 5

5.1  Whereas as the time of execution of the present Deed, there were [NUMBER] Trustees appointed, the Donor may at all times during the term of the trust increase the number of Trustees holding office, by appointing another person or other persons or corporation, by instrument in writing, to act as Trustee or Trustees in addition to the existing Trustees; provided that no such appointment shall take effect until after such time as the existing Trustees have provided a proper accounting of the Trust Property from the time of their designation as Trustees until the date of such appointment. The Donor may also, at any time during the term of this trust, decrease the number of Trustees holding office, by delivering to any Trustee an instrument in writing relieving such Trustee of his office.

5.2  Should any difference of opinion at any time exist among the Trustees in relation to the commission or omission of any acts, or otherwise, howsoever in the execution of the Trust herein, the opinion of the majority of such Trustees shall prevail and such decision so taken shall be sufficient for all purposes and be final and binding upon the Trust Property, the Beneficiaries and all other parties concerned and any one of the Trustees who dissented from a decision taken by a majority of the Trustees, is hereby relieved from all responsibility with respect thereto.

5.3  The Trustees may divide the duties of their offices among themselves as they may from time to time deem advisable, and further, any Trustee, with the consent of his, her or its Co-Trustee, with the consent of his, her or its Co-Trustee or Co-Trustees, may be relieved of any and all powers, duties and discretion in and by this Deed vested in or imposed upon him, her or it, by delivering to the other Trustee or Trustees an instrument in writing delegating the same, or any part thereof, to such other Trustee or Trustees (being the remaining Trustee or Trustees) and any act done or decision made pursuant to such written instrument shall be binding upon and not subject to question or challenge by any person whomsoever. The Trustees, by instrument in writing, may provide that only one or more of their number may exercise any and all powers, duties and discretion vested in them jointly, but provided always, that any such delegation of powers, duties and discretion shall only relate to the management and administration and operation of the Trust or any property, business, firm, investment or other asset in which it is interested, and shall under no circumstances apply or permit the delegation of any power, duty or discretion vested in the Trustees in relation to the power to appoint or advance income or capital of the Trust Property to or amongst any one or more of the Beneficiaries herein.

5.4  Any Trustee hereunder being a chartered accountant, notary or lawyer or engaged in any other profession or business may make and be paid all usual professional and other charges for work done by him or his firm or any member thereof in relation to the administration of this Trust in the same manner in all respects as if he were not a Trustee hereof, and also his reasonable charges in addition to disbursements for all work and business done and all time spent by him and his firm or any member thereof in connection with matters arising in the premises including matters which might or should have been attended to in person by a Trustee not being a chartered accountant,  notary or lawyer or other professional person but which such Trustee might reasonably require to be done by a chartered accountant or solicitor or other professional person.

ARTICLE 6

6.1  A Trustee may resign at any time, without assigning any reason therefore or without obtaining any judicial authorization by giving not less than [NUMBER] days notice in writing addressed to the other Trustees and the Donor. In the event of the resignation, death, incapacity or inability or refusal to act of any Trustee the remaining Trustees, by instrument in writing, subject to the provisions of sub-paragraph 5.1 hereof, may appoint some person or some trust company to fill such vacancy, provided always that only such persons as are residents of [COUNTRY] shall be eligible to serve as a Trustee. Furthermore any Trustee who ceases to be resident in [COUNTRY], shall be disqualified from serving in such capacity any further, and shall be replaced in accordance with the provisions hereof.

6.2  Should the remaining Trustees be unable to agree, or should no Trustees remain, such vacancy or vacancies shall be filled by a Judge of the Superior Court of the [State/Province] of [STATE/PROVINCE], in the usual manner, upon the request of any interested party.

6.3  The Trustees shall render to the Beneficiaries an annual account of their administration.


ARTICLE 7

The Trustees shall not be obliged to give security for their administration in any place nor shall they be obliged to make further inventory or appraisal of any of the Trust Property than they deem advisable.


ARTICLE 8

The Trustees shall not be liable for any error in judgment or for any act of omission or omissions not amounting to actual fraud in the management and administration of the Trust Property.


ARTICLE 9

In effecting any distribution of benefits under the present Trust the Trustees shall withhold and appropriately remit such amounts as are respectively required under the Income Tax Act, [COUNTRY] or any applicable provincial Income Tax Act.


ARTICLE 10

The Trustees are authorized and empowered to execute all deeds and documents and to do all things that may be necessary or appropriate to carry out the powers herein granted.


ARTICLE 11

The Trust Property and benefits accruing therefrom to any one or more of the Beneficiaries shall remain the sole, separate and exclusive property of such Beneficiary and shall not fall into any community of property or partnership of acquests nor shall be included in any calculation of such Beneficiarys family property as determined by any law relevant to such Beneficiary in the event that they or any one of them should marry or are married.


ARTICLE 12

The Trust created by this Deed shall be known as the [NUMBER] TRUST.
ARTICLE 13

The parties hereto have required that the present deed and all deeds, documents or notices relating thereto be drafted in the English language.


WHEREOF ACTE:

THUS DONE AND PASSED at the said City of [CITY], on this [DATE] and remains of record in the office of the undersigned [Attorney/Notary] under the Number of his (her) original [attorney/notarial] Minutes.
AND AFTER DUE READING HEREOF [YOUR COUNTRY LAW] herein have hereby signed these presents with and in the presence of the undersigned Notary.



          
Notary


IN WITNESS WHEREOF, each party to this agreement has caused it to be executed at [PLACE OF EXECUTION] on the date indicated above.


DONOR             FIRST TRUSTEE



                          
Authorized Signature          Authorized Signature


                          
Print Name and Title          Print Name and Title


SECOND TRUSTEE           THIRD TRUSTEE



                          
Authorized Signature          Authorized Signature


                          
Print Name and Title          Print Name and Title


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