Free Microsoft Word - cert of trust - domestic stat trust.DOC - Connecticut

CERTIFICATE OF TRUST
DOMESTIC STATUTORY TRUST
Office of the Secretary of the State
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6003 DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6003

Space for Office Use Only

Filing Fee: $60.00

Make Checks Payable To "Secretary of the State"

1. NAME OF STATUTORY TRUST:

______________________________________________________________________________________
2. ADDRESS OF THE STATUTORY TRUST'S PRINCIPAL OFFICE:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
3. APPOINTMENT OF STATUTORY AGENT:

Name of Agent

Business Address

Residence Address

Acceptance of appointment __________________________________________________________________________ Signature of Agent

4. EXECUTION BY ALL TRUSTEES:
Dated this _________________day of ____________________, 20_______. Type or print names of signing trustees Signatures

Reference an 8 1/2 X 11 attachment if additional space is required
Rev. 08/23/2007