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.  



Dated: _____________________________ at __________, _____________





________________________________________________ 

Custodian for _______________ under Uniform Transfers to Minors
Act