Grantor Information Name Street Address City County State Zip Code Telephone Email Occupation Spouse's Name Spouse's Occupation Co-Grantor Information (if applicable) Name Street Address City County State Zip Code Telephone Email Occupation Spouse's Name Spouse's Occupation Capital Contribution & Payment Capital Contribution ($) Interest on Trust Records Indicate how your interest should be shown on the trust records (choose one). Individual Joint Tenancy Tenants in Common Company * Trustee ** IRA Corporation *** Other (Describe) Describe * If a limited liability company, please include a copy of the Articles of Organization, Operating Agreement and a certificate of action of the manager(s) or other document authorizing the investment. ** If a custodian, trustee or agent, please include a copy of the trust, agency or other agreement and an entity certificate authorizing the investment. *** If a corporation, please include a copy of the Articles of Incorporation and a certified corporate resolution or other document authorizing the investment. Beneficiary Information (for Inheritance Purposes) While a designation of your beneficiary is not required for investment, you may provide the information below. If you live in a state with community property statutes and do not designate your spouse as the sole primary beneficiary, you represent and warrant that your spouse has consented to such a designation. Primary Beneficiary Contingent Beneficiary Beneficiary Name Address City State Zip Submit
