Fillable Trustee Certication Adding or Removing Trustees (Fidelity Investments)

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Trustee Certication Adding or Removing Trustees (Fidelity Investments)

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1.791053.112 018940801
1. Trust Information ALL fields are required.
Provide the tax reporting
number for the trust. A
decedent’s SSN cannot
be used as the tax
reporting number.
Trust Account Number
Trust Name Enter full trust name as evidenced by the trust document.
Trust Social Security or Tax ID Number
SSN
OR
TIN
Date of Trust MM DD YYYY
For a domestic trust, provide the state. For a foreign trust, provide the country.*
* Your trust documents set forth the terms of your trust. Based on these documents, please tell us which state’s laws
apply to your trust. If your trust is subject to foreign law, please tell us which country’s laws apply.
Questions? Go to Fidelity.com or call 800-343-3548.
Form continues on next page.
Trustee Certification — Adding or Removing Trustees
Use this form to add or remove a trustee(s) on your Fidelity Brokerage or Mutual Fund Only Trust, Fidelity
®
Cash Management Trust, Trust 529
Plan, or Investment-Only account. Do NOT use this form if the trust’s Taxpayer ID number (TIN or SSN) is changing. Instead, complete a Change
of Account Registration form (brokerage), a Change of Account Ownership form (mutual fund), or a Fidelity Trust Account Application. Type on
screen or fill in using CAPITAL letters and black ink. If you need more room for information or signatures, make a copy of the relevant page.
Helpful to Know
• To add or remove a trustee on an existing account, ALL
remaining trustees MUST complete Sections 3 and 4,
as applicable, and sign in Section 5.
• If the existing account has margin trading, options
trading, and/or account authority, new forms must be
completed to maintain the features on the account.
Visit Fidelity.com to obtain the necessary forms.
• If you have the ability to write a check on this account
(even if you have never written one), you must also
complete a new Checkwriting form to add or remove a
trustee on the associated signature card.
• If a debit card has been issued to a trustee who is being
removed from an account, you may call the number on
the back of the card at any time to request the card to be
closed. If the debit card remains open after a trustee has
been removed, his or her debit card will be deactivated.
• If you are establishing a NEW Trust 529 Plan Account,
a 529 Plan Account Application MUST accompany this form.
Additional Documentation Requirements
– Fidelity Certification of Trust form
– OR if your account is in the name of a foreign trust, or if you
prefer not to complete the Fidelity Certification of Trust form,
you will need to certify your trust by providing a copy of
the pages of the trust document that includes the full name
of the trust, trust date, name of the updated or successor
trustee(s) that match the trustee(s) listed in this form, and all
signatures. Do not include the entire trust document, and
it must be in English.
– If your account is an Investment-Only account (also known
as a Non-Prototype account), you are required to provide
a copy of the pages of the plan or trust document that
includes the full name of the plan or trust, plan or trust
date, name(s) of the updated or successor trustee(s) that
match the trustee(s) listed in this form, and all signatures.
Do not include the Fidelity Certification of Trust form,
or the entire trust or plan document.
– Any other required documents as indicated in the
appropriate sections of this form (if applicable).
Page 1 of 8
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1.791053.112
018940802
2. Add or Remove Trustee(s)
Complete the information below for each trustee to be added or removed from the account. If there is more than one trustee resigning, make
one or more copies of this section and have all resigning trustees complete and sign this section. All remaining and new trustees, grantors, and
any others with the authority to appoint/remove trustees and/or revoke/amend the trust must provide their information in Sections 3 and 4, as
applicable, and all trustees must sign in Section 5.
Naming a successor trustee(s)
I (We)
Name(s) of Successor Trustee(s)
certify that I am (we are) the successor trustee(s) of the above-named trust in accordance with the terms of the
trust instrument.
Adding a co-trustee(s)
I (We)
Name(s) of Co-trustee(s)
certify that I am (we are) the co-trustee(s) of the above-named trust in accordance with the terms of the
trust instrument.
Removing/Replacing a trustee
Name of Trustee
Reason:
Death of trustee. Include a copy of the death certificate and a state tax waiver, if required by the decedent’s state
of residence.
Incapacitation of trustee. Include copies of the pages from the trust that govern the appointment of a successor
trustee, along with a letter signed by the attending physician on the physician’s letterhead and dated within the
past 90 days, which indicates a state of permanent mental incapacitation. Please do not send a copy of the whole
trust. If the trust or plan has more stringent requirements for incapacitation, provide additional documentation as
required to satisfy those requirements.
Resignation of trustee. Resigning trustee must sign below.
Court order. Include a certified copy of the court order.
Other
Indicate Reason
Resigning Trustee Signature
By signing below, the undersigned hereby certifies that he or she is resigning as trustee of the above-named trust.
A Medallion signature guarantee is required if the value of the account is over $100,000.
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can get a
Medallion signature guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a signature guarantee.
PRINT RESIGNING TRUSTEE NAME
RESIGNING TRUSTEE SIGNATURE
SIGN
X
TODAY’S DATE MM-DD-YYYY
DATE
X
MEDALLION SIGNATURE GUARANTEE
Form continues on next page.
Page 2 of 8
1.791053.112 018940803
3. Primary Trustee Information
Provide the following information for the primary trustee. To provide information for any additional trustee(s), grantor(s), or any others with the
authority to appoint/remove trustees and/or revoke/amend the trust remaining on the account OR being added to the account, you can do so in
Section 4 and have all trustees sign in Section 5. Do not make copies of Section 3 for additional individuals.
Trustee only
Trustee and grantor
Authority to appoint/remove trustees
Authority to revoke/amend the trust.
Trustee is an entity If the trustee is an entity, check the box, enter full entity name as evidenced by the relevant
formation document (e.g., trust document, partnership agreement, articles of incorporation), and a completed
Fidelity Trustee Certification or Fidelity
®
Brokerage Business Account Certification form, as applicable, is
required. All required forms and supporting documentation must be provided at the time this form is submitted,
or we will be unable to process this request.
First Name Middle Name Last Name
Entity Name
Date of Birth MM DD YYYY Social Security or Taxpayer ID Number
SSN OR TIN
Primary Phone
Mobile Number
Secondary Phone
Mobile Number
Email
If you provided an email address, you have indicated your preference to receive communications electronically.
Fidelity will email you instructions to enroll and consent to eDelivery of all eligible documents, or you can go
to Fidelity.com/eDelivery to enroll once this request is processed.
Residential Address (where you live) This is your legal address used for tax reporting.
Note: This address will
also be used to update
the trust’s permanent
address.
Street Address
City State ZIP Code
Mailing Address Including PO box, drop box, or c/o location.
Note: This address will
also be used to update
the trust’s mailing
address.
Same as residential address Default if no other information is indicated below.
Mailing Address
City State ZIP Code
Citizenship
U.S. citizen
Foreign citizen Information in this box must be completed.
Permanent U.S. resident Non-permanent U.S. resident Nonresident of U.S.
Country of Citizenship Country of Tax Residency Only applicable to nonresidents of the U.S.
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign National Identity Document
Required.
Check ALL that apply.
Enter full first and last
name as evidenced by
a government-issued,
unexpired document (e.g.,
driver’s license, passport,
permanent resident card).
Provide phone number(s)
to be used to verify and/or
authorize transactions.
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government ID
showing number and photo.
Primary Trustee Information continues on next page.
Page 3 of 8
1.791053.112
018940804
Income Source
Employed Self-employed
Occupation Employer Leave blank if self-employed.
Employer Address
City State/Province ZIP/Postal Code Country
Retired Not employed
Source of Income Pension, investments, spouse, etc.
Associations
If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial Industry
Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or an immedi-
ate family member residing in the same household of someone who meets the aforementioned employment criteria,
provide the company’s name and address below. By providing this information and completing this form, you hereby
authorize Fidelity to provide the associated person’s employer with duplicate copies of confirmations and statements,
or the transactions data contained therein, for your account(s) and any accounts you choose to have on a consolidated
statement for purposes of their compliance review.
Company Name
Company Address
City State/Province ZIP/Postal Code Country
Affiliations
If you, your spouse, or any of your relatives (including parents, in-laws, and/or dependents, etc.), living in your home (at
the same address), is a member of the board of directors, a 10% shareholder, or a policy-making officer of a publicly traded
company (an “Affiliate”), you must provide the information below. If there are more than two Affiliates, make a copy of
this section.
Affiliate’s Company Name Trading Symbol or CUSIP
Affiliate’s Company Name Trading Symbol or CUSIP
Check one and
provide information.
Industry regulations
require us to ask for
this information.
As a person associated
with a member firm, you
are obligated to receive
consent from that firm.
Fidelity has existing
consent agreements
with many firms for
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If
your firm is not one
of them, Fidelity will
attempt to contact your
firm’s compliance office.
3. Primary Trustee Information, continued
Form continues on next page.
Page 4 of 8
1.791053.112 018940805
4. Additional Individual Information
Provide the following information for each additional trustee, grantor, and any others with the authority to appoint/remove trustees and/or
revoke/amend the trust remaining on the account OR being added to the account. If there are more than two individuals, make a copy of
Section 4 and have all trustees sign in Section 5.
Trustee only
Trustee and grantor
Living Grantor only*
DECEASED Grantor* Provide ONLY full
legal name
Authority to appoint/remove trustees*
Authority to revoke/amend the trust*
Trustee is an entity If the trustee is an entity, check the box, enter full entity name as evidenced by the relevant
formation document (e.g., trust document, partnership agreement, articles of incorporation), and a completed
Fidelity Trustee Certification or Fidelity
®
Brokerage Business Account Certification form, as applicable, is required.
All required forms and supporting documentation must be provided at the time this form is submitted, or we will
be unable to process this request.
* These individuals will be listed as Beneficial Owners and will not have any authority or be able to take any action on
this account or receive any account documentation, unless they are also trustees or granted account authority. If the
Beneficial Owner is an Entity, a separate Beneficial Ownership for Trusts form, or Beneficial Ownership – Control Person/
Entity Owner for Entities form, as applicable, must be attached.
First Name Middle Name Last Name
Entity Name
Date of Birth MM DD YYYY Social Security or Taxpayer ID Number
SSN OR TIN
Primary Phone
Mobile Number
Secondary Phone
Mobile Number
Email
If you provided an email address, you have indicated your preference to receive communications electronically.
Fidelity will email you instructions to enroll and consent to eDelivery of all eligible documents, or you can go
to Fidelity.com/eDelivery to enroll once this request is processed.
Residential Address (where you live) This is your legal address used for tax reporting.
Street Address
City State ZIP Code
Mailing Address Including PO box, drop box, or c/o location.
Same as residential address Default if no other information is indicated below.
Mailing Address
City State ZIP Code
Required.
Check ALL that apply.
Enter full first and last
name as evidenced by
a government-issued,
unexpired document (e.g.,
driver’s license, passport,
permanent resident card).
Provide phone number(s)
to be used to verify and/or
authorize transactions.
Additional Individual Information continues on next page.
Page 5 of 8
1.791053.112
Citizenship
U.S. citizen
Foreign citizen Information in this box must be completed.
Permanent U.S. resident Non-permanent U.S. resident Nonresident of U.S.
Country of Citizenship Country of Tax Residency Only applicable to nonresidents of the U.S.
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign National Identity Document
Income Source Required ONLY for trustees.
Employed Self-employed
Occupation Employer Leave blank if self-employed.
Employer Address
City State/Province ZIP/Postal Code Country
Retired Not employed
Source of Income Pension, investments, spouse, etc.
Associations Required ONLY for trustees.
If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial Industry
Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or an immedi-
ate family member residing in the same household of someone who meets the aforementioned employment criteria,
provide the company’s name and address below. By providing this information and completing this form, you hereby
authorize Fidelity to provide the associated person’s employer with duplicate copies of confirmations and statements,
or the transactions data contained therein, for your account(s) and any accounts you choose to have on a consolidated
statement for purposes of their compliance review.
Company Name
Company Address
City State/Province ZIP/Postal Code Country
Affiliations
If you, your spouse, or any of your relatives (including parents, in-laws, and/or dependents, etc.), living in your home (at the
same address), is a member of the board of directors, a 10% shareholder, or a policy-making officer of a publicly traded
company (an “Affiliate”), you must provide the information below. If there are more than two Affiliates, make a copy of this
section.
Affiliate’s Company Name Trading Symbol or CUSIP
Affiliate’s Company Name Trading Symbol or CUSIP
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government ID
showing number and photo.
Check one and
provide information.
Industry regulations
require us to ask for
this information.
As a person associated
with a member firm, you
are obligated to receive
consent from that firm.
Fidelity has existing
consent agreements
with many firms for
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If
your firm is not one
of them, Fidelity will
attempt to contact your
firm’s compliance office.
018940806
4. Additional Individual Information, continued
Form continues on next page.
Page 6 of 8
1.791053.112 018940807
5. Trustee Certifications and Signatures
Please be sure to read all the language included on the following pages, as well as sign, date, and return all pages of this form
(1–8) to Fidelity.
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC; National Financial Services LLC; Fidelity Service Company, Inc.;
Fidelity Management Trust Company; Fidelity Distributors Company LLC, and their affiliates; and their respective employees, agents, representatives,
shareholders, successors, and assigns as the context may require; “you” refers to the undersigned trustee(s).
By signing below, you:
• Certify as Trustee that:
– Every trustee has signed below (or you
are the sole trustee, if applicable) and is
authorized to make these statements.
– The trust has not been revoked, modified,
or amended in any manner that would
cause the statements contained in this trust
certification to be incorrect.
– The trust exists under all applicable laws.
– You have the authority under the trust and
applicable law to enter into transactions,
delegate trading authorization to the other
authorized individuals, issue instructions
on this account for, and at the risk of,
the trust, and agree that all transactions
and instructions will be in full compliance
with the trust. You understand that all
such transactions and instructions will be
governed by the terms and conditions of all
other agreements applicable to this account.
– You will inform Fidelity, in writing, of any
change in the composition of the trustees,
or any other event that could alter the
certifications made herein.
– The certifications, authorizations, and
appointments in this form will continue until
we receive written notice of any changes in
sufficient time to provide us a reasonable
opportunity to act. Any revocation shall not
affect any instruction or transaction initiated
before its receipt.
– You authorize us to accept orders and other
instructions for this account from any trustee
and/or any other authorized individual or
entity. This includes the authority to deliver
any or all assets in the account to any trustee
(personally or otherwise) or according to
any trustee’s instructions. We, at our option
and for our protection, may require approval
of other trustees before acting on any such
order or instruction.
– We are not responsible for any claim, loss,
expense, or other liability for acting upon
any instructions given by the trustees and/or
implementing any transactions.
• Represent and warrant that if you have not
completed the section titled Associations,
you are not employed by nor associated with
a broker-dealer, stock exchange, exchange
member firm, FINRA, a municipal securities
dealer, or any other financial institution, nor
are you the spouse or immediate family
member residing in the same household of
such a person.
• Represent and warrant that if you have not
completed the section titled Affiliations, none
of you, your spouse, nor any of your relatives
living in your home are a control person
or affiliate of a public company under SEC
Rule 144.
• Certify that all information provided in this
form is true, accurate, and complete.
• Agree to jointly and severally indemnify
Fidelity and hold Fidelity harmless from any
claim, loss, expense, or other liability for
acting pursuant to the instructions given by
the trustees. The trustees further agree not to
give any instructions for which they are not in
full compliance with the Trust.
• Acknowledge that we may verify all
information provided in connection with this
form and account, and may obtain credit
or other financial responsibility reports with
respect to the trust, the trustees, and any
authorized individuals; and you have the
express consent of all individuals who may be
the subject of these reports. If requested in
writing, we will provide the name and address
of the credit reporting agency used.
For Trust 529 Plan Accounts:
• Certify every trustee has the power to change
the Beneficiary on the 529 College Savings
Plan account.
For Fidelity
®
Cash Management Trust Accounts:
• Agree to inform Fidelity in writing if
any change in the composition of the
beneficiaries would alter the certifications
made herein or otherwise cause any person
or entity other than natural persons to
become a beneficiary.
Trustee Certifications and Signatures continues on next page.
Page 7 of 8
1.791053.112
To help the government fight financial crimes, federal regulation requires Fidelity to obtain and verify your name, date of birth, address, and
a government-issued ID number before opening your account, and to verify the information. In certain circumstances, Fidelity may obtain and
verify comparable information for any person authorized to make transactions in an account. Also, federal regulation requires Fidelity to obtain
and verify the beneficial owners and control persons of legal entity customers. Requiring the disclosure of key individuals who own or control
a legal entity helps law enforcement investigate and prosecute crimes. Your account may be restricted or closed if Fidelity cannot obtain and
verify this information. Fidelity will not be responsible for any losses or damages (including, but not limited to, lost opportunities) that may result
if your account is restricted or closed.
A Medallion signature guarantee is required:
• for the successor trustee if you are removing a trustee and the value of the trust is more than $100,000.
•
for the current trustee(s) if you are adding a co-trustee and the value of the trust is more than $100,000.
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can
get a Medallion signature guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a
signature guarantee.
ALL remaining and new trustees must sign. If there are more than two trustees, make a copy of this page.
PRINT TRUSTEE NAME
TRUSTEE SIGNATURE
SIGN
X
TODAY’S DATE MM-DD-YYYY
DATE
X
MEDALLION SIGNATURE GUARANTEE
PRINT ADDITIONAL TRUSTEE NAME
ADDITIONAL TRUSTEE SIGNATURE
SIGN
X
TODAY’S DATE MM-DD-YYYY
DATE
X
MEDALLION SIGNATURE GUARANTEE
018940808
5. Trustee Certifications and Signatures, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided
by Fidelity Brokerage Services LLC, Member NYSE, SIPC. All trademarks and service marks indicated herein are the
property of their respective owners. 404060.12.0 (03/21)
Did you sign the form and attach any necessary documents?
Send the ENTIRE form and any attachments to Fidelity Investments. You will
receive a “Revised Account Profile.”
Questions? Go to Fidelity.com or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0039
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1C
Covington, KY 41015
Page 8 of 8
1.900844.110
Fidelity Certification of Trust
Use this form to certify your trust to Fidelity. This form is for domestic trusts only. Do NOT use this form for foreign trusts. If your account
is in the name of a foreign trust, or if you prefer not to complete this form, certify your trust by providing pages of the trust document
that include the full name of the trust, trust date, name of the trustee(s), and all signatures. Do not include the entire trust document.
Some states require trustee signatures to be notarized (see page 2 for specific states).
Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information or signatures, make a copy of the relevant page.
1. Trust Information ALL fields are required unless indicated otherwise.
Provide the tax reporting
number for the trust.
Trust Name Enter full trust name as evidenced by the trust document.
Trust Account Number Date of Trust MM DD YYYY
Trust Taxpayer ID/Social Security Number
Grantor Name(s)
Trustee Name
Co-Trustee Name Required if there is more than one trustee. If there are more than two trustees, make copies of this form.
Name(s) of the person(s) who can AMEND the trust Field cannot be left blank.
Name(s) of the person(s) who can REVOKE the trust Field cannot be left blank.
Provide which state’s laws apply to your trust.*
* Your trust documents set forth the terms of your trust. Based on these documents, please tell us which state’s laws
apply to your trust.
2. Trustee Certification ALL trustees must sign and date on the next page.
In this form, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC, National Financial Services LLC, and their affiliates; and their respective
employees, agents, representatives, shareholders, successors, and assigns as the context may require. “You” refers to the undersigned trustee(s).
Each trustee must sign and date this form. Make copies of this page and the next as needed.
By signing on the next page, you certify as trustee that:
• To help the government fight financial crimes,
federal regulation requires Fidelity to obtain
your name, date of birth, address, and a
government-issued ID number before opening
your account, and to verify the information. In
certain circumstances, Fidelity may obtain and
verify comparable information for any person
authorized to make transactions in an account.
Also, federal regulation requires Fidelity to
obtain and verify the beneficial owners and
control persons of legal entity customers.
Requiring the disclosure of key individuals
who own or control a legal entity helps law
enforcement investigate and prosecute
crimes. Your account may be restricted or
closed if Fidelity cannot obtain and verify this
information. Fidelity will not be responsible
for any losses or damages (including, but not
limited to, lost opportunities) that may result if
your account is restricted or closed.
• The trust has not been revoked, modified, or
amended in any manner that would cause the
statements contained in this trust certification
to be incorrect.
• The trust exists under all applicable laws.
• There are no trustees of the trust other than
those listed above. Every trustee (whether
you are the sole trustee or there is more than
one) has signed below and is authorized to
make these statements. Should only one
person execute this agreement, it shall be a
representation that the signer is the sole trustee.
• You agree to inform Fidelity, in writing, of any
change in the composition of the trustees,
or any other event that could alter the
certifications made herein.
• You have the authority under the trust and
applicable law to enter into transactions and
issue the instructions that you make on behalf
of the trust account with Fidelity. The trustees
understand that all such transactions and
instructions will be governed by the terms and
conditions of all other account agreements
applicable to this account. The trustees further
agree not to give any instructions for which
they are not in full compliance with the trust.
• Fidelity has the authority to accept instructions
relative to the account from those individuals
listed as trustees in Section 1. They may
execute any documents on behalf of the trust
that Fidelity may require, and each trustee may
act independently.
• Fidelity is authorized to follow the instructions
of any trustee and to deliver funds, securities,
or any other assets in the account to any
trustee on any trustee’s instructions, including
delivering assets to a trustee personally.
Fidelity, in its sole discretion and for its sole
protection, may require the written consent
of any or all trustees before acting on the
instructions of any trustee.
• All information provided in this form is true,
accurate, and complete.
• You agree to indemnify Fidelity (jointly and
severally) from and hold Fidelity harmless
for any and all losses, liabilities, claims, and
costs (including reasonable attorneys’ fees)
resulting from our effecting any transaction
or acting upon any instruction given by you
or any authorized agent, advisor, or any third
party you authorize on the account, or from
your action or inaction, whether intentional
or not, including losses resulting from the
action or inaction of any authorized agent,
advisor, or any other third party you authorize
on the account. You further agree that the
indemnifications in this bullet are in addition
to, and do not limit, any rights that Fidelity may
have under any other agreement with you.
• Where applicable, plural references in this
certification shall be deemed singular.
Enter full first and last name as
evidenced by a government-issued,
unexpired document (e.g., driver’s
license, passport). If grantor/trustee
is an entity, enter full entity name as
evidenced by the relevant formation
document (e.g., trust document,
articles of incorporation).
Write “none” on
each line if there
are
no person(s)
who can
AMEND or
REVOKE
the trust.
022771001
Questions? Go to Fidelity.com or call 800-343-3548.
Trustee Certification continues on next page.
Page 1 of 2
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1.900844.110
022771002
2. Trustee Certification, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by
Fidelity Brokerage Services LLC, Member NYSE, SIPC. 532335.10.0 (08/21)
Did you sign the form and attach any necessary documents? Send
the ENTIRE form and any attachments to Fidelity Investments.
Questions? Go to Fidelity.com or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0039
Overnight mail
Fidelity Investments
Account Reregistration Services
100 Crosby Parkway KC1C
Covington, KY 41015
PRINT TRUSTEE NAME
TRUSTEE SIGNATURE
DATE MM /DD/YY YY
SIGN
X X
PRINT TRUSTEE NAME
TRUSTEE SIGNATURE
DATE MM /DD/YY YY
SIGN
X X
Important Note: CA Notaries are permitted to submit a separate page notary document. If used, it must identify the document being notarized.
Certificate of Acknowledgement of Notary Public Must
be a U.S. Notary. Foreign notary or consular seals may NOT be substituted.
State of _______________________________, in the County of
______________________________,
s
ubscribed and sworn to
before me by the above-named trustee who is personally known to
me or who has produced _________________________________
as identification, that the foregoing statements were true
and accurate and made of his/her own free act and deed, on
______/______/____________ .
PRINT NOTARY NAME
NOTARY SIGNATURE
DATE MM /DD/YY YY
SIGN
X X
NOTARY SEAL / STAMP
My commission expires ______/______/____________ .
Certificate of Acknowledgement of Notary Public Must
be a U.S. Notary. Foreign notary or consular seals may NOT be substituted.
State of _______________________________, in the County of
______________________________, subscribed and sworn to
before me by the above-named trustee who is personally known to
me or who has produced _________________________________
as identification, that the foregoing statements were true
and accurate and made of his/her own free act and deed, on
______/______/____________ .
PRINT NOTARY NAME
NOTARY SIGNATURE
DATE MM /DD/YY YY
SIGN
X X
NOTARY SEAL / STAMP
My commission expires ______/______/____________ .
Notice to CA Residents: A Notary Public or other officer completing this certificate verifies only the identity of the individual
who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
Your trust documents set forth the terms of your trust. Based on these documents, you can identify which
state’s laws apply to your trust. All trustee signatures MUST be notarized if your trust is governed by the laws
of California, Delaware, Idaho, Iowa, Kansas, Michigan, Minnesota, Mississippi, Nebraska, Nevada, South Dakota,
Tennessee, or Vermont.
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Trustee Certication Adding or Removing Trustees (Fidelity Investments)

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Completed 16 February 2022

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