Declaration of Life Insurance Trust

9/6/2013

This Declaration of Insurance Trust is made this __(1)__ day
of __(2)__, 20_(3)_, by and between _____(4)_____, of
_____(5)_____, hereinafter called the Trustor, and
_____(6)_____, of _____(7)_____, hereinafter called the
Trustee.

I.

The Trustor, as owner of certain life insurance policy or
policies listed below, and desiring to establish a Life
Insurance Trust, with power in the Trustee upon the death of
the Trustor to purchase assets from Trustor's estate, assigns
to the Trustee all his right, title, and interest in the
policy or policies of insurance, to be held by Trustee in
trust, and to receive the
proceeds of the policy or policies of insurance when they
become due and are paid, for the purposes and on the
conditions set forth herein. The Trustor reserves the right to
add to this trust from time to time additional life insurance
policies which, when delivered to the Trustee, shall be held
by him subject to the terms herein.

(Description of Life Insurance policies)

II.

The Trustee is vested with all right, title, and interest in
the life insurance policy or policies, and is authorized and
empowered to exercise and enjoy, for the purposes of the trust
and as absolute owner of the policy of insurance, all the
options, benefits, rights, and privileges under the policy or
policies. The Trustor relinquishes all rights and powers in
the life insurance
policy or policies which are not assignable and will, at the
request of the Trustee, execute all other instruments
reasonably required to effectuate this relinquishment. The
trustee shall
receive and hold said Life Insurance policies, together with
any additions thereto, in trust for the use and benefit of:

(List names of Beneficiaries)

III.

Upon the death of the Trustor, the Trustee may, within his
discretion, purchase assets from Trustor's estate at a fair
value.  The propriety of the purchase, the amount of such
assets purchased, and the ascertainment of fair value shall be
solely within the discretion of the Trustee, and the Trustee
shall incur no liability as a result of the purchase or
purchases whether or not the assets constitute investments
which may be legally made by Trustee.

IV.

If the Trustee uses all or any portion of the proceeds of the
policy of insurance to purchase assets from the estate of the
Trustor, as authorized above, then the net income produced
from the assets, or the proceeds of any sale, exchange, or
reinvestment of the assets, shall be paid to the spouse of the
Trustor during the spouses's lifetime.

V.

If any beneficiary of this trust who is at the time receiving
income would otherwise, in the opinion of the Trustee, be
subject to hardship or suffering, the Trustee shall have the
authority to pay over and distribute, at any time and from
time to time, to the beneficiary the amounts of the principal
of this trust, from which the beneficiary shall then be
entitled to receive income as the Trustee, in his sole
discretion, shall deem necessary to provide for the
maintenance, comfort, support, and medical care of the
beneficiary.

VI.

This Life Insurance Trust shall be irrevocable and
unamendable. I am aware of the consequences of establishing an
irrevocable trust and hereby affirm that the trust created by
this
agreement shall be irrevocable by me or any other person, it
being my intention to make to the beneficiary/beneficiaries
named herein an absolute gift of the Life Insurance policies
described in
paragraph I above.

VII.

This agreement and the trust created hereby shall be
administered, managed, governed and regulated in all respects
according to applicable statutes of the State of
_____(8)_____.

VIII.

The Trustee, in addition to all other powers granted by this
agreement and by law, shall have the following additional
powers with respect to the trust, to be exercised from time to
time at the Trustee's discretion:

Management of the Trust

To invest and reinvest, lease, rent, mortgage, insure, repair,
improve or sell any of the real and personal property of the
trust as he may deem advisable.

Mortgages, Pledges and Deeds of Trust

To enforce any all mortgages, pledges and deeds of trust held
by the trust and to purchase at any sale thereunder any such
real estate or personal property subject to any mortgage,
pledge of deed or trust.

Litigation

To initiate or defend, at his discretion, any litigation
affecting the trust.

Attorneys, Advisors and Agents

To employ and pay from the trust reasonable compensation to
such attorneys, accountants, brokers, and investment., tax and
other advisors as he shall deem advisable.

Adjust of Claims

To submit to arbitration, to compromise or to release or
otherwise adjust with or without compensation, any and all
claims affecting the trust estate.

IX.

No bond for the faithful performance of duties shall be
required of any Trustee appointed under this agreement.

X.

The trustee shall receive reasonable compensation for the
services performed by him, but such compensation shall not
exceed the amount customarily received by corporate
fiduciaries in the area for like services.

XI.

No Trustee of the trust created by this agreement shall at any
time be held liable for any action or default of himself, or
of his agent, or of any other person in connection with the
administration and management of this trust unless caused by
this own gross negligence or by commission of a willful act of
breach of trust.

XII.

The Trustee, by joining in the execution of this agreement,
hereby signifies his acceptance of this trust.

XIII.

The Trustee shall have sole authority to determine what shall
be defined as income and what shall be defined as principal of
the trust established by this agreement, and to determine
which costs, taxes and other expenses shall be paid out of
income and which shall be paid of out principal.

XIV.

In the event that any portion of this agreement of the trust
created hereby shall be held illegal, invalid or otherwise
inoperative, it is my intention that all of the other
provisions hereof shall continue to be fully effective and
operative insofar as is possible and reasonable.

IN WITNESS WHEREOF, the parties hereto have executed this
agreement the day and year first above written.

_________(9)_________    _________(10)_________
              Trustor
_________(9)_________

_________(9)_________    _________(11)_________

_________(9)_________


STATE OF _______(12)_______)

COUNTY OF _______(13)______)

On this __(14)__ day of ______(15)______, 20 _(16)_, before me
personally came and appeared ______(17)______, known, and
known to me, to be the individuals described in and who
executed the foregoing instrument, and who duly acknowledged
to me that he executed same for the purpose therein contained.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

                               ___________(18)___________

                    My Commission Expires:______(19)_____

Notice

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.

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