Trust Examiner School eBook

Trust Officer’s Questionnaire (Continued)

19. If any director is now or since the previous examination has been ineligible or disqualified from serving as a director for any reason, furnish the name and reason. If none, so state.

I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief.

Officer’s Name and Title

Department Name and Location (City and State)

Officer’s Signature

Date

This is an official document. Any false information in it may be grounds for prosecution and may be punishable by fine or imprisonment.

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