(Top 3 inches reserved for recording data) CERTIFICATE OF TRUST by Individual Minn. Stat. 501C.1013 State of Minnesota, County of Minnesota Uniform Conveyancing Blanks Form 90.1.1 (2016) , being first duly sworn on oath states, or affirms under penalties of perjury, that: 1. The name of the trust, if one is given, is: 2. The date of the trust instrument is: . . 3. The name and address of each trustee empowered to act under the trust instrument at the time of execution of this Certificate of Trust is: 4. The trustees are authorized by the trust instrument to sell, convey, pledge, mortgage, lease, or transfer title to any interest in real or personal property, except as limited by the following: (if none, so indicate) 5. The number of trustees required to act is: 6. The trust has has not (check one box) been terminated. been revoked. The trust instrument has has not (check one box) Pursuant to Minn. Stat. 501C.1013 subd. 2: The name of each settlor of the trust is: The name of each original Trustee is: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 90.1.1 Check this box if an Affidavit of Trustee, consisting of _____ pages, is attached to this Certificate of Trust. The statements contained in this Certificate of Trust are true and correct and there are no other provisions in the trust instrument, or amendments to it, that limit (i) the powers of the trustee(s) to sell, convey, pledge, mortgage, lease, or transfer title to interest in real or personal property, or (ii) the authority of the trustees to exercise any other power identified in this Certificate of Trust. Trustee or Settlor (signature) (signature) Signed and sworn to (or affirmed) before me on (month/day/year) (insert name of Trustee or Settlor making statement) , by . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) American LegalNet, Inc. www.FormsWorkFlow.com