Form CHAR001-LT (201) Form CHAR001-LT Registration Statement for Charitable Lead TrustsNew York State Department of Law (Office of the Attorney General)Charities Bureau - Registration SectionNew York, NY 10www.charitiesnys.com Open to PublicInspectionFor Registration of Lead Trusts Only (remainder trusts use CHAR001-RT,charitable organizations use CHAR410,estates submit Notice of Probate)Part A - Identification of Registrant1.Full Name of Trust7.Full Name of Grantor/Testator2.c/o Name (individual, law firm, etc.)8.Fed. employer ID no. (EIN)3.Mailing address (Number and street)Room/suite9.Date of Trust and any Amendments/CodicilsCity or town, state or country and ZIP+410.Type of Trust:Inter vivos................................GTestamentary.............................G4.Phone5.Fax6.Email address11.Fiscal Year End (mm/dd)Part B - Identification of Trustees (list information for each trustee)NameAddressPart C.1. - Identification of Remainder Beneficiaries (list information for each remainder beneficiary)NameDate of Death (if applicable)Description of InterestPart C.2. - Identification of Charitable Lead Beneficiaries (list information for each charitable lead beneficiary)Organization NameFederal EINLead Interest End DateDescription of InterestPart D - Attachments - All Documents RequiredAttach a copy of the trust instrument to this Registration Statement.Part E - Certification Signature Printed Name Title Date American LegalNet, Inc. www.FormsWorkFlow.com