DECLARATION OF LIFE INSURANCE TRUST

This Declaration of Insurance Trust is made this ______ day of ______, 19 ____, by and

between ____________, of ____________, hereinafter called the Trustor, and ____________, of

____________, 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 ____________.

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.

______________________ ______________________

Trustor

______________________

______________________ _______________________

______________________

STATE OF ________________)

COUNTY OF _______________)

On this ______ day of ______________, 19 ____, before me personally came and

appeared ______________, 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.

________________________

My Commission Expires:_____________