APPLICATION, RELEASE AND DISCLOSURE

At my request, a representative of the Northern New England Conference of Seventh-day Adventists has spoken with me concerning my desires for the distribution of my estate, including the possibility of my desire to leave a portion of my estate to the Seventh-day Adventist Church organization. I hereby request the Northern New England Conference of Seventh-day Adventists to process this application for a Trust, Will, Annuity or other document in harmony with information presented.

I recognize that my Will should be prepared by an attorney and specifically understand that the Conference representative is not an attorney. Consequently, I choose attorney:

_________________________________of (City)____________________(State)______

I have been fully advised that all legal documents may be reviewed by legal counsel on retainer with the Northern New England Conference. This attorney will verify that all legal documents are in accordance with my instructions in this application and State of ______________________________law.

I have discussed with the conference representative certain personal and financial matters and I specifically authorize and request the representative to communicate with the attorney(s) mentioned above in accordance with the preparation of the requested documents. I also understand that I will be able to contact such attorneys if I have any questions; however, I have been urged to contact my own retained attorney for independent counsel.

I understand that I/we are responsible to see that these legal documents are executed properly. And I further understand that if I choose to remember the Conference in my Will or Trust then the Northern New England Conference will assume responsibility for the payment of attorney’s fees for drawing up such documents.

_____________________________________________Date_______________________

(Applicant’s signature)

_____________________________________________Date_______________________

(Applicant’s signature)