Introduction

I, [YOUR NAME], the undersigned Trustee of the [NAME OF TRUST] (the "Trust"), under the laws of the State of Florida, hereby swear and affirm under penalty of perjury the following statements:

Statement of Facts

1. The [NAME OF TRUST], was established on [TRUST CREATION DATE], under the terms of a Trust Agreement dated [TRUST AGREEMENT DATE], a copy of which is attached hereto as Exhibit A.

2. I, [YOUR NAME], am the duly appointed Trustee of the Trust and have full authority to act on behalf of the Trust in all matters relating to its assets and administration.

3. The Trust is irrevocable and currently in full force and effect.

4. The Trust is governed by the laws of the State of Florida.

5. The Trust's taxpayer identification number is [TRUST'S TIN].

6. The Trust's principal place of administration is [ADDRESS OF TRUST'S PRINCIPAL PLACE OF ADMINISTRATION].

Sworn Oath

I, [YOUR NAME], do solemnly swear that the foregoing statements are true and correct to the best of my knowledge and belief. I understand that any false statements made herein are subject to penalties for perjury.

Executed on this [DATE] day of [MONTH], [YEAR] in the State of Florida.

[YOUR NAME], Trustee

State of Florida

County of [COUNTY]

Subscribed and sworn to before me this [DATE] day of [MONTH], [YEAR] by [YOUR NAME], the Trustee of the [NAME OF TRUST], known to me to be the person who executed the foregoing instrument and who took an oath.

[NOTARY PUBLIC STAMP]

[NOTARY PUBLIC NAME], Notary Public

My Commission Expires: [COMMISSION EXPIRATION DATE]

Notary Public ID: [NOTARY ID NUMBER]

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