HomeMy WebLinkAbout874703 Recording requested by:
WELLS FARGO BANK, N.A. f:t ~ C. t'~* I t,/E ~ '
.-lNt.3Ot,.kt ()OUN'f'Y OLER
When recorded return to:
BILL NOS, MT 59107
~ State of Wymnh~g . . Space Above Tiffs lane For Rceordh~g Dafa
REFERENCE ~: 200 q q ~52~00040 ' ACCOST ~: 0654-654- q 006 q 85-0001
MORTGAGE
(With Future Advance Clause)
1. DATE AND PARTIES. The date o£this Mortgage ("Security Instnnnent") is 06 / 29 ! 200 q
and the parties, their addresses and tax identificaion numbers, if required, are as follows:
MORTGAGOR:THEODORE K, GROVES AND MARGO J, GROVES, OR THEIR SUCCESSORS,
AS CO-TRUSTEES OF THE GROVES FAMILY TRUST, BEING TH,aT CER'IAIN L1NRECOROF_'D
TRUST CREATED ON THE 14TH DAY OF AUGUST, 1998
[] If checked, refer to the attached Addendum incorporated herein, for additional Mortgagors their signatures and
acknowledgments.
LENDER: WELLS FARGO ]FLANK N.A. , ,
P. O. BOX 3155-7 ' .~
BILLINGS, MT 50105
2. CONVEYANCE. For good and valuable consideration, the receipt and sufficiency of which is acknowledged, and to secure
the Secured Debt (defined below) and Mortgagor's performance nnder this Security Instrument, Mortgagor grants, bargains,
convey_s, mortgages and warrants lo Lender, with p. ower of sale, the following described proferty:
LOT SIXTY-TWO (82) IN STAR VALLEY RANCH PLAT SEVEN F-l) AS PEAT'TED AND
RECORBED IN THE OFFICIAL RECORDS OF L NCOLN COUNTY, WYOMING,
with an address of44~ REDWOOD ROAD THAYNE WY 83127
and parcel number of 35'1 [~3010201200 together with all rights, easements, at)purteuances, royalties, mineral
rights, oil and gas rights, all ~vater and riparian rights, ditches, and water stock and all existing and future improvements,
structures, fixtures, and replacements that may now or at any time in the future be part of the real estate described above (all
referred to as "Property.'").
3. MAXIMUM OBLIGATION LIMIT. The total principal amount secured by this Security 17nstmment at any one time shall not
exceed $ 'i 00,000.00 , This li~nitation of amount does not include interest and other fees and charges validly made
pursuaut to this Security Instrument. Also, this limitation does not apply to advances made under the terms of this Security
Iustrument lo protect Lender's security and to perform any of the covenants contained in this Security Instmntent.
4, SECURED DEBT AND FUTURE ADVANCES. The term "Secured Debt" is defined as follows:
A. Debt incurred nnder the terms of the promissm'y note, revolving line of credit, contract, guaranty or other evidence of
debt dated 06 / 2~ / 2001 together with all amendments, extensions, modifications and renewals, and having a
maturity date of 08/29t2031
B, All flm~re advances from Lender to Mortgagor under such evidence of debt. All lhture advances are secured as if made
on the date of this Security lnstmntent. Nothing m this Security Agreement shall constitute a commitment to make
additional or future loans or advances which exceed the amount shown in Sectiou 3. Any such commitment must be
agreed to in a separate writing,
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C. "All sums advanced and expenses incurred by Lender for insuring, preserving, or otherwise protecting tile Property
and its value and auy other su~ns advanced and expenses incurred by Lender under the terms of this Security
!nstrummTt.
5. PAYMENTS. Mortgagor agrees that all payments under the Secured Debt will be paid when due and in accordance with tile
terms of the Secured Debt and this Security Instrument.
6. .PRIOR SECURITY INTERESTS, With regard to any other mortgage, deed of trust, security agreement or other lieu
document that created a prior security interest or encumbrance on the Property, Mortgagor agrees: A. To make all payments when due and to perform or comply with all covenants.
B. To promptly deliver to Lender any notices that Mortgagor receives from the holder.
C. Not to allow any modification or extension of, nor to request any filture advances raider any note or agreement secured
by the lien document without Lender's prior written consent.
7. cLAIMS AGAINST TITLE. Mortgagor will pay all taxes, assessments, liens, encumbrances, lease payments, gi:ound renIs,
utilities, and other charges relating to the Property when due, Lender may require Mortgagor to provide to Lender copies of all
notices that such amounts are due and the receipts evidencing Mortgagor's payment. Mortgagor will defend title to the Property
against any claims that would impair the lien of the Security Instrument, Mortgagor agrees to assign to Lender, as requested by
Lender, any rights, claims or defenses Mortgagor may have against parties who supply labor or materials lo maintain or iinprove
the Property.
8, DUE ON SALE OR ENCUMBRANCE, 'Upon sale, transfer, hypothecation, assignment or encumbrance, whether voluntary,
im,oluntary, or by operation of law, of all or any part of the Property or any interest therein, then at its sole option, Lender xnay,
by written notice to Mortgagor, declare all obligations, secured hereby immediately due and payable, except to the extent that
such acceleration for and in such particular circumstances wlmre exercise of such a right by Lender is prohibited by law.
9. PROPERTY CONDITION, ALTERATIONS AND INSPECTION. Mortgagor will keep the Property in good condition and
make all repairs that are reasonably necessary. Mortgagor shall not commit or allow any waste, impair~nent, or deterioration of
the Property. Mortgagor will keep the Property free of noxions weeds and grasses. Mortgagor agrees that the nature of the
occupancy and use will not substantially change without Lender's prior written consent. Mortgagor will not permit any change
in any license, restrictive covenant or easmnent'iwithout Lender's prior written consent. Mortgagor will notify Lender of all
demands, proceedings, claims, and actions against Mortgagor, and of any loss or damage to the P.roperty. Lender or
Lender's agents Inay, at Lender's option, enter ihe Property at an), reasonable time for the purpose of inspecting the'Property.
Lender shall give Mortgagor notice at the time of or before an inspection specifying a reasonable puq)ose for the inspection.
Any inspection of the Propgrty shall be entirely for Lender's benefit and Mortgagor will in no way rely on Lender's inspection.
10. AUTItORITY TO PERFORM. If Mortgagor fails to perform any duty or any of the covenants contained in this Security
Instrument, Lender may, without notice, perform or cause them to be performed. Mortgagor appoints Lender as attorney in fact
to sign Mortgagor's name or pay any amount necessary for performance. -Lender's right to perform for Mortgagor shall not
create an obligation to perform, and Lender's failure to perform will not preclude Lender from. exercising any of Lender's oilier
rights under the law or this Security Instrument. If any construction on the Property is discontinued or not carried on in a
reasonable manner, Lender may take all steps necessary to protect ender s security interest in the Property, including
completion of the construction.
11. ASSIGNMENT OF LEASES AND RENTS. Mortgagor irrevocably grants, bargains, conveys, mortgages and warrants to
Lender as additional security all the right, title and to any and all existing or fi~ture leases, subleases, and any other written or
verbal agreements for the use and occupancy of any portion of the Property, including any extensions, renewals, lnodifications or '
substitutions of such agreements (all referred to as "Leases") and rents, issues and profits (all referred to as "Rents"). Mortgagor
will promptly provide Lender with true and correct copies of all existing and fiiture Leases. Mortgagor may collect, receive,
enjoy and use the Rents so long as Mortgagor is not in default under the terms of this Security Instrument.
MortgagOr agrees that this, assignment is immediately effective between the parties to this Security Instrumentl Mortgagor agrees
that this assignment is effective as to third parties when Lender takes affirmative action prescribed by law, and that this
assignment will remain in effect dtiring cay redemption period until the Secured Debt is satistied. Mortgagor agn';.'cs that Lender
may take actual possession of the property without the necessity of commencing legal action and that actual possession is
deemed t6 occur when Lender, or its agent, notitles Mortgagor of default and demands that any tenant pay all filture Rents
directly tn'Lender. On receiving notice of default, Mortgagor will endorse and deliver to Lender any payment of Rents in
Mortgagor's possession and will receive any Rents in trust for Lender and will not commingle the Rents with any other flmds.
Any amounts collected will be applied as provided in this Security Instrument. Mortgagor Warrants that no default exists under
the Leases or any applicable landlorddtenant law. Mortgagor also agrees to maintain and require any tenant to comply with the
terms of the Leases and applicable law.
12, LEASEHOLDS; CONDOMINIUMS; PLANNED UNIT DEVELOPMENTS. Mortgagor agrees Io comply with the
provisions of any lease if this Security Insmunmxt is on a leasehold. If the property is a nnit m a Condominium Project or is part
of a Planned Uuit Development ("PUD"), Mortgagor agrees to the following:
A. Obligations. Mortgagor shall perform all of Mortgagor's obligations under the Constituent D0cnments. The
"Constituent Docmnents" are the: (i) Declaration or any other document which creates the Condominium Projects or PUD and
.any homeowners association or equivalent entity ("Owners Association"); (ii) by-laws; (iii)code of regnlations; and (iv) other
EQ150B (3/2001)
eq!.livalgnt documents. Mortgagor shall promptly pay, when dtte, all dries aud assessmenis inlposed pursuant to tho Conslitllellt
Documents.
B. Hazard Insurance. So long as lhe Owners Association maintains, with a generally accepted insurance carrier, a
"~naster" or "blanket" policy on the Condominium Project or PUD which is satisfactory to Lender and which provides insurance
coverage in the amounts, for the periods, and against the hazards Lender requires, including fire and hazards included within
the term "extended coverage," then Mortgager's obligation under Section 19 to maintain hazard insurance coverage on the
Property is deemed satisfied to tile extent that the required coverage is provided by the Owner's Association policy. Mortgagor
shall give Lender prompt notice of an5, lapse in required hazard insurance coverage. In the event of a distribution of hazard
insurance proceeds in lieu of restoration or repair following a loss to Property, whether to the unit or to common elements, any
proceeds payable to Mortgagor are hereby assigned and shall be paid lo Lender for application to the sums seem'ed by this
Security Instrmnent, with any excess paid to Mortgagor,
C, Flood Insurance. Mortgagor agrees to maintain flood insurance for the life of the Secured Debt which is acceptable,
as to form, amount and extent of coverage to Lender
D. Public Liability Insurance. Mortgagor shall take such actions as may be reasonable to insure that the Owners
Association maintains a public liability insurance policy acceptable in form, amount, and extent of coverage to Lender,
E. Condemnation, The proceeds of any award or claim for damages, direct or consequential, payable to Mortgagor in
connection with any condemnation or other taking of all or any part of the Property, whether of the unit or of the common
elmnents, or for any conveyance in lieu of condemnation, are hereby assigned and shall be paid to Lender, Such proceeds shall
be applied by Lender to the sums secured by the Security Instrument as ProVided in Section 18.
F. Lender:s Print Consent. iMortgagor shall not, except after notice m Lender and with Lender's prim' ~¥ritten consent,
either partition or subdivide the Property or consent to: (i) tile abandonment or termination of the Condominimn Project or
PUD, except for abandonment or termination required by law in the case of substantial destruction by fire or other casualty or in
the case of a taking by condemnation or eminent domain; (ii) any amendment to any provision of the Constituent Documents if
the provision is for the express benefit of Lender; (iii) termiuation of professional management and assumption of self-
management by the Owners Association; or (ix;)any action which would have the effect~ of rendering the public liability
insurance coverage maintained by the Owners Association unacceptable to Lender,
G. Remedies. IfMortgaga~ does not pay condomininm or PUD dues and assessments when due, iben Lender may pay
them Any amounts disbursed by Lender under this section shall becmne additional debt of Mortgagor secured by this Security
Instrument. Unless Mortgagor and Lender agree to other terms of payment, these amounts shall bear interest frmn the date of
disbursement at the Secured Debt rate and stlall be payable, with interest, upon notice from Lender to Mortgagor requesting
payment.
13. DEFAULT. Mortgagor will be in default if any party obligated on the Secured Debt fails to make .payment when due,
· Mortgagor will be iii default if a breach occurs under the terms of this Security Instrument or any other document executed for
the purpose of creating, securing or guarantying the Secured Debt, A good faith belief by Lender that Lender at any time is
insecure with respect to any person or entity obligated on the Secured Debt or that the prospect of any payment or Ihe value of
the Property is impaired shall also constitute an event of default.
14. REMEDIES ON DEFAULT. In some instances, federal and state law will require Lender to provide Mortgagor with notice of
the right to cure or other notices and may establish time. schedules lbr foreclosure actions. Subject to these limitations, if any,
Lender may accelerate the Secured Debt and foreclose this Security Instrument in a manner provided by law if Mortgagor is in
default,
At the option o:f Lender, all or any part of the agreed fees and charges, accrued interest and principal sliall become im~nediately
due and payable, after giving notice if required by law, upon the occurrence of a default or anytime thereafter. In addition,
Lender shall be entitled to all the remedies provided by law, tile terms of the Secured Debt, this Security Instrumeut and any
related documents, including without limitation, the power to sell the Property, All remedies are distinct, cunmlative and not
exclusive, and the Lender is entitled to all remedies provided at law or equity, whether or not expressly set forlh. The
acceptance by Lender of an), sum in payment or partial payment on the Secured Debt after the balance is due or is accelerated or
after f6re'61osure.proceedings are filed shall not constitute a waiver of Lender's right to require complete cure of any existing
default By not exercising any remedy on Mortgager's default, Lender does not waive Lender's right to later consider the event
a default if it continues or happens again.
15, EXPENSES; ADVANCES ON COVENANTS; ATTORNEYS' FEES; COLLECTION COSTS. Except when prohibited by
law, Mortgagor agrees to pa3' all of Lender's expenses if Mortgagor breaches any covenant in this Security Instnunent,
Mortgagor will also pay on demand auy amount incurred by Lender for insuring, inspecting, preserving or otherwise protectiug
the Property and Lender's security interest, These expenses will bear interest from the date of the payment until paid in fi~ll at
the highest interest rate in effect ;is provided in tile terms of tile Secured Debt, Mortgagor agrees to pay all costs and expenses
recurred by Lender in collecting, enforcing or protecting Lenders' rights and reinedies tinder this Security Instrument. This
amount may include, but is not limited to, attorneys' fees, conrt costs, and other legal expenses. This ammmt does not include
attorneys' fees for a salaried cmplosee of tile Lender. This Security Instrument shall remain in effect until released. Mortgagor
agrees to pay for any recordation costs of such release,
EQ150C (3/2001)
16. ENVIRONMENTAL LAWS AND tlAZARDOUS SUBSTANCES. As used in thi; section, (1) Environmental Law means,
'without limitation, the Comprehensive Enwroumental Response, Compensation and Liability Act (CERCLA, 42 U.S.C. 9601 et
seq0, and all other federal, state and local laws, regulations, ordinances, court orders, attorney general opinions or interpretive
letters concerning the public healtt~, 'safety, welfare, environment or a hazardous substance; and (2) Hazardous Substance means
any toxic, radioactive or hazardous material, waste, pollutant or contaminant which has characteristics which render the
substance dangerous or potentially dangerous to the public health, safety, welfare or environment. The term includes, without
limitation, any substances defined as "hazardous matcrial," "toxic substances," "hazardous waste" or "hazardous substance"
under any Environment;al Law.
Mortgagor represents, warrants and agrees that:'
A. Except as previously disclosed and acknowledged in writing to Lender, no Hazardous Substance is or will be located,
stored or released on or in the Property. This restriction does not apply to small quantities of ttazardous Substances
that are geneyally recognized to be appropriate for the normal use and maintenance of the Property.
B. Except as previonsly disclosed and acknowledged in writiug to Lender, Mortgagor and every tenant have been, are, and
shall remain in full compliance with any applicable Environmental Law.
C. Mortgagor shall immediately notify Lender if a release or threalened release of a Hazardous Substance occurs on, under
or about the Property or there is a violation of any Enviromnental Law concerning the Property. in such an event,
Mortgagor shall take all necessary retnedial action in accordance with any Enviromnental Law.
D. Mortgagor shall immediately notify Lender in writing as soon as Mortgagor has reason to believe there is any pending
or threatened investigation, claim, or proceeding relating to the release or threatened release of any Hazardous
Substance or lite violation of any Environmental Law.
17. CONDEMNATION. Mortgagor will give Lender prompt notice of any pending or threatened actiou, by private or public
entities to purchase or take any or all of the Property through condemnation; etninent domain, or any other means. Mortgagor
authorizes Lender to intervene in Mortgagor' name in any of the abox)e described actions or claims. Mortgagor assigns to
Lender the proceeds of any award or claim for d,amages connected with a condemnation or other taking of all or any part of the
Property. Such proceeds shall be considered t~ayments and will be applied as provided in this Security Instrument, This
assignment of proceeds is subject to the tertns of'any prior mortgage, deed of trust, security agreement or other lien document.
18. INSURANCE.. Mortgagor shall keep Property insured against loss by fire, flood, theft and other hazards and risks reasonably
associated with the Property due to its type and location. This insurance shall be maintained in the amounts and for the periods
that Lender requires. The insurance carriei providing the insurance shall be chosen by Mortgagor subject to Lender's approval,
which shall not be unreasonably withheld. If Mortgagor fails to maintain the coverage described above, Lender ~nay, at Lender's
option, obtain coverage to protect Lender's rights in the Property according to the terms of this Security Instrument.
All insurance polici.cs and renewals shall be acceptable to Lender and shall include a standard "mortgage clause" and, where
applicable, "loss payee clause." Mortgagor shall immediately notify Lender of cancellation or termination of the insurance.
Lender shall have the right to hold the policies and renewals. If Lender requires, Mortgagor shall immediately give to Lender
all receipts of paid prmnimns and renewal notices. Upon loss, Mortgagor shall give immediate notice to thc insurance carrier
and Lender. Lender may make proof of loss if not made immediately by Mortgagor.
Unless otherwise agreed in writing, all insurance proceeds shall be applied to the restoration or repair of the Property or to the
Secured Debt, whether or not then due, at Lender's option. Any application of proceeds to principal shall not extend or postpone
the due date of the scheduled payment nor change the amount of an)' payment. Any excess will be paid to Mortgagor. If the
Property is acq~ired by Lender, Mortgager's right to any insurance policies and proceeds resulting from damage to/tie Property
before the acquisition shall pass to Lender to the e. xtent of the Secured Debt immediately before the acquisition.
.19. ESCROW FOR TAXES AND INSURANCE. Unless Otherwise provided in a separate agreement, Mortgagor will not be
required to pay to Lender fi,~nds for taxes and insurance in escrow.
2(I, FINANCIAL REPORTS AND ADDITIONAL DOCUMENTS, Mortgagor will provide to Lender upon request, any
financial statement or information Lender may deem reasouably necessary. Mortgagor agrees to sign, deliver', and file auy
additional documents or certifications that Lender may consider necessary to perfect, continue, and preserve Mortgager's
obligatiofis under this Security Instrument and Lender's lien status ou the Property.
21, JOINT,AND INDIVIDUAL LIABILITY; CO-SIGNERS; SUCCESSORS AND ASSIGNS BOUND. All duties under this
Security Instrument are joint and indMdual. If Mortgagor signs this Security Instrument but does not sign an evidence of debt,
Mortgagor does so only to mortgage Mortgager's interest in the Property to secure payment of the Secured Debt and Mortgagor
does not agree to be personally liable on the Secured Debt. If this Security Instrument secures a guaranty between Lender and
Mortgagor, Mortgagor agrees to waive any rights that may prevent Lender from bringing any action or claim against Mortgagor
or an5' party indebted under the obligation. These rights may include, but are not limited to, any anti-deficiency or one-action
laws. Mortgagor agrees that Lender and any party to this Security Instrument may extend, modify or make any change in the
terms cf this Security Instrument or any evidence of debt without Mortgager's consent. Such a change will not release
Mortgagor from the terms of this Security Instrument. The duties and benefits of this Security instrument shall bind and benefit
lhe successors and assigns of Mortgagor and Lender.
22. APPLICABLE LAW; SEVERABILITY; INTERPRETATION. This Security Instrument is governed by the laws of the
EQ150D (3/2001)
jmjisdiction in which the Property is located, except to the extent otherwise required by the laws of the jurisdiction where the
Property is located. This Security Instmmem is complete and fiflly integrated. This Security Instrument may not be ameuded of
modified by oral agreement. Any section in this Security lnstntment, attachments, or any agreement related to the Secured Debt
that conflicts with applicable law will not be effective, unless that law expressly or impliedly permits the variations by written
agreement. If any section of this Security Instmn~ent cannot be enforced according to its terms, that section will be severed and
will not affect the enforceability of the remainder of this Security Instrument. Whenever used, the singular shall include the
plural and the plural the singular. The captions and headings of the sections of this Security Instrument are for convenience
only and are not to be used to interpret or define the terms of this Security Instrument. Time is of the essence m this Security
Instrument. In the event any section of this Security hmtrmnent directly conflicts with any section of a certain Home Equity
Closing Handbook which contains the Account Agreement Terms and Conditions (as applicable), Fixed Rate Note Terms and
Conditions (as applicable), the Arbitration Agreement, and the Agreement to Provide Flood/Property Insm'ance, all of which i
agree to by s~gning this Securit~y Instm~nem, the terms of the Home Equity Closing Handbook shall control.
221. NOTICE. Unless otherwise required by law, any notice shall be given by delivering it or by mailing it by first class mail m the
apprepnate party's address on page 1 of this Security Instrument, or as shown in Lender's records, or to any other address
designated in writing.
24. WAIVERS. Except to the extent prohibited by law, Mortgagor waives any right regarding the marshallin g of liens and assets,
and hereby releasing and waiving all rights under and by virtue of the homestead exemption laws of this state.
25, OTHER TERMS. If checked, ll~e following are applicable to this Secmity Instrument:
[5~-"] Line of Credit, The Secured Debt includes a revoMng line of credit provision. Although the Secured Debt may be
reduced to a Zero balance, this Security Instrument will remain in effect until released,
~ Construction Loan. This Secur!B, Instrument secures an ot)ligation incurred for the construction of an improvement
on the Propekty.
~1 Fixture Filing. Mortgagor grants to Lender a security interest in all goods tt~at Mortgagor owns now or iu the fi~ture
and that are or will become fixtures relates to the Property. This Security Instm~nent.suffices as a financing statement
and any carbon, photographic or otber:~reproduction may be filed of record for purposes of Article 9 of the IJniform
Commercial Code.
~?X'] Additional Terms.
SIGNATURES: By signing below, Mortgagor agrees to the terms and covenants contained in this Securib' Instnmtent and in any
attachments. Mortgagor also acknowledges receipt of a copy of this Security Instrmnent on the date stated on page 1.
THE B RE K GROVES', ~ Mortgagor Date
Mortgagor Date
Mortgagor Date
Mortgagor Date
Mortgagor Date
Mortgagor Date
EQ150E (3/2001)
'-,' ....... .i I 0
ACKNOWLEDGMENT:
(Individual)
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before
this
Wimess my hand and official seal.
(S~tur¢ oFOffieer)
k/
ACKNOWLEDGMENT:
(Individual)
STATE OF
COUNTY OF
The foregoing instrmnent was acknowledged before me by
this ~q day of
Witness my hand and official seal.
(Title of Offi~r~ , ' ..........................
m Commission Expires:
(Seal)
EQ150F (3/2001)
CERTIFICATION OF TRUST , ' 'k i 1
,~ .. :,. ~. (for trusts located in all states except Oregon)
Reference Nu mber:~F__L~. B 0 0 0 A 0 _.
Account Number: D~E A-~SA- 1F10~ 1 ~.a-G00 '1
This Certification is Inade by the undersigned (individually or collectively, "Trustee"), in his or her capacity as a trustee of
the __ _ ~ ~o 4o~ 3rx~ {~t_~"li'~'at (the "Trust") for the beucfit of
WELLS FARGO BANK, N. AL ("Bank"). Trustee certifies, represents and warrants aS follows:
1. In cmmection with credit extended or to be extended by Bank to
THEODORE K GROVES, TRUSTFE
MARGO J GROVES, TRUSTEE
ll~e Trustee has executed or shall execute documen{ation which provides for tim Trustee, inter ali_~a to (check as applicable):
(A) [~ Borrow money;
(B) [~ Grm~t I!o Bank a security interest and/or lien in all or cerlain assets of ihe Trust.
2. Trustee'has the auflmrity to enter into the transactiou with the respect to which tiffs Certification is being delivered, m~d the
transaction will create a binding obligation on the assets of the Trust.
3.. All information contained in this certification is true and correct, and Bank aS a third party conducting business with the
Trustee may rely on this iIfformafion until fl~e Bank receives written notice of any changes signed by the Trustee.
4. The Trust has not been revoked, modified or amended in any roamer which would cause the representations contained in this
certification to be incorrect.
5. This certification is signed by ail of the ctm:ently acting trustees of the Trust.
The undersigned declares m~der penalty of perjury that the foregoing is tree and Correct, and that this certification was
executedat lit, So Nt~,,.: T~... o~
Trustee(s) of Trust '
~__D
By:
By: Date:
By; Date:
THIS FORM CAN ONLY BE USED FOR A REVOCABLE TRUST
STATE OF___~O~/trl ~
~tk.c~tt County
Ou J ~ 'k~ before me ~. ~Ja.,~ ~, d[~,~ Nota~ Public, personally appeared:
[~'personally known to me -OR- [ ] proved to me on fi~e basis of satisfacto~ evidence to be the
person(s) whose' natne(s) is/are subscribed to the withiu insmm~ent m~d ac~owledged to me flint he/she/fl~ey executed the same in
his/her/flmir auflmrized capacity(ies), and tbat by his~er/Omir signature(s) on O~e instrument ltte persgn(s) or fl~e entity upon behalf of
which O~e person(s) acted, executed the instrument.
WITNESS my hand and offici~ seal
Name (typed or printed)
My commission expires:
EQ300 (7/2000~ ,~.