TRANSFER UNDER THE ______ STATE UNIFORM GIFT TO MINORS ACT

I, __________________, hereby transfer to ____________, as

custodian for _________________, a minor, residing at ___________,

______, under the Uniform Transfers to minor act the following:

_________________________________________________________________

Dated at ___________, __________________: ______________________

_______________________________________________

RECEIPT

I, ____________, acknowledge receipt of the property described

above as custodian for the minor above named under the Uniform

Transfers to Minors Act.

As such custodian I waive and prospectively waive for the full

term that I serve as custodian compensation as provided in

Section 15 of the Uniform Transfers to Minors Act.

Dated: _____________________________ at ____________, ________

________________________________________________

Custodian for _________________ under Uniform Transfers to Minors

Act