Nominee Trust
___________________ Nominee Trust Schedule of Beneficiaries(Not to be recorded)The undersigned hereby certifies that it is (the sole) Beneficiary of the _____________________________ Nominee Trust established under Declaration of Trust dated ____________________, 20______, and that the following is its beneficial interest thereunder: Percentage ofBeneficiary Beneficial Interest______________________________________________ (100%)(pursuant to written agreement dated _______________, 20_________.)The terms of said Trust are hereby approved and the undersigned Beneficiary agrees with the Trustees of said Trust: (a) to be bound by said Trust; and, (b) to save the Trustees harmless from any personal liability for any action taken at the direction of the Beneficiaries, or for any error of judgment, or for any loss arising out of any act or omission in the execution of the Trust so long as the Trustees act in good faith; and, (c) that the Trustees may withhold from any distribution, transfer or conveyance such amounts as they from time to time reasonably deem necessary to protect themselves from such liability; and (d) that each Trustee shall be responsible only for such Trustee’s own willful breach of trust; and, (e) to reimburse the Trustees for any expenses incurred in the performance of their duties.Executed as a sealed instrument this ______ day of ___________________, 20 _______. __________________________________________[Attach appropriate acknowledgement certificate here](See reverse for Trustees Receipt and Caveats in using this form.)Adopted November 20, 1989REBA Form No. 20A ................
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