ÿWPC¶ ª¸ª·Yþˆ_Ü”_ܼ,#!qÖ“\ÖÝ‚÷Zx/W*Å¡~ ¥v¸ò ,³ÚŽ’uœ÷¾®;FÜð¬P+¢ôFš¼Ð–TRN±´êkeÞ­}´âb!´6ª¥r Øw®Üô€ª¼ƒèYŽ0éëµÎ_X]ƒo©–Š8…±•·¶j¾Jdì´ºÿcR¨…ÒÄçwÍ{ëÙbTqsE5AÞBÒWAýM|S¡T·ËÒMäxå¦{)SöÆòVS†UÕU 0úèøø¹cj‹ë'³ïï4óáìC‚lÏa¢‹4ò3O¼vÎ!Ý…J0¤YoEÙ/ÅÒ´A:'6‡Gn’¸˜Ì#ÒjÈ€!ÜÖ¡È]K ¼=}óO!öå®—½c3:$.G‘5ôª‡rÖm¥†!AÅ}¸ÖÃû¢‡Z yõÅÙ3å ¤w2K΂`ƒ5]*Χš]hÏì`ü(/ëý°6ËU…æ¬míPG?c:Ö? ¸èWìæR¢Á3ûë|çCøú|I [Øøò"×K6±b2áQ«Ýâ>”OÐ|Ad¢<2¦Ê‚É€eÿN¼ NB›†ÜÆš‹ l˜ÒÐoÀì-š„»a„Ån!FJå#!†UN§ %õ 0kûU>fUN¤ 1uò^ gw@s4³ÇÖ mØØØØØØØØØØØØØØØØØØØØØØØØØ 1uïïïfdd 1ifffffffff B ÏÏÏÏfìììfîîîîîîaðððððf Æ 0eÌÌÌÌÌÌÌa1aE YYYf_aaaafuuuuuuufwayyyyyyyy D3fÀaÂaÖÖfêaìììììafaf*a,f@aBfVaXflannnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn‚˜®ÄÚð2H^tŠ ˜HP LaserJet 4M Plus,ð,,,,,ð0(ÈhH  Z6Times New Roman RegularX(Ch$¡¡Ô€XbKXXXÔÔ  ÔÔ  ÔÓ  Ó/LÀÄ AZ&Univers Regular(ÖÃ9 Z ‹6Times New Roman Regular3#37=CIQYag­­1.a.i.(1)(a)(i)1)a)s‚¹$¬ DDDD D D U DýŒµ$LE ° †3|x ÿU‹ÿÀÀÀ7#137=CIQYag³³1.a.i.(1)(a)(i)1)a)L$ÿÿ35;AGMU]c1A.1.A.1.(1)(a)i)a) d‰‰TABLE B‰1, 2, 3,Level 1Level 2Level 3Level 4Level 54#;N2Quick 1.ÚƒJÚÚ  Ú.à0 àÛ€JÛTABLE BTABLE BÈ ®TABLE J‰LTABLE C4444'ÿÿdxdLTABLE DTABLE B¬TABLE ETABLE F¬TABLE EJTABLE Gð»TABLE HD†TABLE I‰TABLE BAppendix DAppendix EAppendix FAppendix GAppendix HAppendix IAppendix JAppendix KAppendix LAppendix MAppendix NAppendix OAppendix PAppendix QÝ ƒh!ÝÔ€XÂ0XXXÔÔ  ÔÔ  ÔÓ  ÓÝ  ÝÔ_ÔññññÔ‡XQXXXÂ0ÔÔ‡”‚XXÂ0Ôññññññññà@,,ìàò òÔ  ÔññññApplication€to€Create€142€TrustÔ ÆÔó óÔ €× ԈР° ÐññññññññÌññññò òññññÌññññÌññññà@êê%ìàNO.€______ˆÐ ° ÐÌ__________________________,€ASà@­­*ìàððˆà0  àà0p(#(#àññññà0Èp(#p(#àññññIN€THE€DISTRICT€COURT€OFÐàp(#p(# ÐGUARDIAN€AD€LITEM€FOR€à@­­*ìàððˆÐ €Ð Ð________________________,à@­­*ìàððˆà0  àà0p(#(#àà È à€€€€ÐpÀp(#p(# Ðòò[A€MINOR]óó€òò[AN€INCAPACITATED€PERSON]óó,à@­­*ìàððˆÐ ` ° Ðà0  àà0` (#(#àà0¸ ` (#` (#àPlaintiff,à@­­*ì¸ (#¸ (#àððˆÐ P   Ðà@­­*ìàððˆà0  àà0p(#(#àññññà0Èp(#p(#àññññ____________€COUNTY,€TEXAS,Ð@ p(#p(# Ðv.à@­­*ìàððˆÐ 0 € Ðà@­­*ìàððˆÌ__________________________,à@­­*ìàððñ ñññÐ `  Ðñññ ñˆà0  àà0p(#(#àà0Èp(#p(#àñ ñññDefñññ ññ ñÐ` È(#È(# Ðñ ññ ñDefñ ñendantà@­­*ìàððˆà0  àñ ñà0p(#(#àñ ñà0p(#(#à____€JUDICIAL€DISTRICTó óÐP p(#p(# ÐÌà@¤ ¤ ìàò òòòAPPLICATION€TO€CREATE€TRUSTˆÐ à0  Ðóóà@ÈÈìàòòUNDER€SECTION€142.005€OF€THE€TEXAS€PROPERTY€CODEó óóóˆÐ Ð  ÐÌà  à___________€("Guardian€Ad€Litem"),€guardian€ad€litem€for€_____________Ï("Plaintiff"),€a€òò[minor]€[incapacitated€person€under€Tex.€Prop.€Code€ðð142.007]óó,€filesÐ  ð Ðthis€Application€to€Create€Trust€Under€Section€142.005€of€the€Texas€Property€CodeÏ(the€"Application").€€In€support€of€this€Application,€Guardian€Ad€Litem€would€show€theÏCourt€as€follows:ÌÌà  à1.à ` àPlaintiff€is€entitled€to€judgment€in€the€above€entitled€and€numbered€cause.€Ð P  Ðòò[Describe€other€parties,€nature€of€judgment,€etc.,€if€desired]óó.Ð @ ÐÌØ€JØà  à2.à ` àPlaintiff€is€òò[a€minor]€[a€person€who€is€impaired€because€of€mental€illness,Ð  p Ðmental€deficiency,€physical€illness€or€disability,€advanced€age,€chronic€use€of€drugs,Ïchronic€intoxication,€or€other€cause€to€the€extent€that€Plaintiff€lacks€sufficientÏunderstanding€or€capacity€to€make€or€communicate€responsible€decisions€concerningÏPlaintiff's€person]óó.Ð à0 ÐÌØ€JØÝ‚u;NÿÝÝ  Ýà  àÝ‚u;N7 ÝÚƒJÚ3Ú  Ú.à0 ` àÝ  ÝPlaintiff€has€no€legal€guardian.݃u;N7 ^ ÝÛ€JÛŒÐÀ!` (#` (# ÐŒÝ  ÝÌà  à4.à ` àCreation€of€a€trust€pursuant€to€Tex.€Prop.€Code€ðð142.005€containing€theÐ  #ð! Ðterms€and€provisions€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€andÏincorporated€herein€would€be€in€the€best€interests€of€Plaintiff.Ìâ âÐ p&À!$ ÐÔ*‹ƒ²4³ddd Xdd Xdd X°(#°(#‹ÔÔ,¤dd ÔÔ+  ÔÐ  ° Ðà@: : ‚àò òOPTIONAL€SUPPLEMENTAL€NEEDS€TRUST€PROVISION:ó óˆÐ d ÐÌØ€JØà l à5.€It€would€be€in€the€best€interests€of€the€Ward€for€the€trust€to€be€a€specialÏneeds€trust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A).ÌÌØ€JØà l à6.à Ä àThe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€andÐ Ä  Ðincorporated€herein€are€necessary€to€establish€a€special€needs€trust€as€specifiedÏâ âunder€42€U.S.C.€Section€1396p(d)(4)(A).Ð ¤ ô ÐÌà  à5.òò[7.]óóà ` à________________€("Trustee")€is€a€trust€company€or€a€state€or€nationalÐ ´   Ðbank€having€trust€powers€in€Texas€and€is€willing€to€serve€as€trustee€of€the€trust€forÏPlaintiff's€benefit.ÌÌà  à6.òò[8.]óóà ` àSection€142.005€(b)€(6)€of€the€Texas€Property€Code€provides€that€theÐ tÄ  Ðtrustee€of€a€trust€created€pursuant€to€Tex.€Prop.€Code€ðð€142.005€shall€receiveÏreasonable€compensation€paid€from€the€trustððs€income,€principal,€or€both€on€applicationÏto€and€approval€of€the€Court.€€Guardian€Ad€Litem€asks€the€Court€to€approve€the€feesÏand€compensation€that€are€payable€to€Trustee€under€the€terms€of€the€trust€instrumentÏapproved€by€the€Court.ÌÌà  à7.òò[9.]óóà ` àUpon€entry€of€judgment€and€creation€of€the€trust,€the€clerk€of€this€courtÐ T Ðand/or€all€parties€to€this€proceeding€holding€funds€which€are€payable€to€or€for€theÏbenefit€of€Plaintiff€should€be€ordered€to€pay€and€deliver€such€funds€to€Trustee€as€partÏof€the€trust€estate€of€such€trust.€òò[Modify€as€needed€to€fit€settlement/judgment€terms.]óóÐ Ô$ ÐÌØ€JØà  à8.òò[10.]óóà ¸ àUpon€entry€of€judgment€and€creation€of€the€trust,€Guardian€AdÐ ´ ÐLitem€should€be€paid€a€reasonable€fee€for€services€rendered,€should€be€reimbursed€forÏexpenses,€and€should€be€discharged€as€guardian€ad€litem€for€Plaintiff.ÌÌà@hh'ìàPRAYERˆÌÌà  àGuardian€Ad€Litem€prays€that€the€Court€will€make€the€findings€andÏdeterminations€described€above,€that€the€Court€will€create€a€trust€for€the€benefit€ofÏPlaintiff€under€Tex.€Prop.€Code€ðð€142.005€with€those€terms€and€provisions€set€forthÏin€Exhibit€"A"€attached€hereto€and€incorporated€herein;€that€the€Court€will€nameÏTrustee€as€trustee€of€such€trust;€òò[that€the€trust€shall€be€a€special€needs€trust€asÐ &d!# Ðspecified€under€42€U.S.C.€Section€1396p(d)(4)(A);]óó€that€the€clerk€of€this€Court€and/orÐ 'T"$ Ðany€party€to€this€proceeding€holding€funds€which€are€payable€to€or€for€the€benefit€ofÏPlaintiff€shall€be€ordered€to€pay€and€deliver€such€funds€to€Trustee€as€part€of€the€trustÏestate€of€such€trust;€that€the€Court€shall€order€that€the€fees€and€compensationÏauthorized€to€be€paid€to€Trustee€by€the€terms€of€the€trust€instrument€are€reasonable;Ïthat€the€Court€will€order€that€the€Trustee€is€authorized€to€pay€itself€such€fees€andÏcompensation€and€reimburse€itself€for€expenses€as€provided€in€the€trust€instrumentÏwithout€further€application€to€or€order€from€this€Court;€that€the€Court€will€awardÐ ”-ä(+ ÐGuardian€Ad€Litem€a€reasonable€fee,€to€be€paid€by€Trustee€upon€funding€of€the€trustÏ(if€not€sooner€paid);€that€the€Court€will€discharge€Guardian€Ad€Litem;€and€that€theÏCourt€will€grant€such€other€and€further€relief€to€which€Plaintiff€may€be€entitled.ÌÌRespectfully€submitted,ÌÌGUARDIAN€AD€LITEMÐ  P   Ðññññà@®®ìàò òÔ  ÔAPPENDIX€E€„„€Trusteeððs€Application€For€Approval€à@@ºº7ìàof€Compensation€(142€Trust)Ô €Ø ÔÔ ŸÔó óˆÐ ° ÐÌÓC€ & #173CÓò òÔ*eƒŒ•4dd¤dd ¤²4³°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  R¢ Ðó óNote€that€Tex.€Prop.€Code€ðð142.005(b)(6)€provides€that€the€trust€must€provide€that€ð ðthe€trustee€receivesÐ ¶ Ðreasonable€compensation€paid€from€the€trustððs€income,€principal€or€both€ò òon€application€to€and€approval€ofÐ ˆØ Ðthe€court.ððó ó€€Rather€than€relying€on€the€guardian€ad€litemððs€application€for€creation€of€the€trust€to€approveÐ \¬ Ðtrustee€compensation,€trustees€can€assure€that€they€meet€the€statutory€requirements€by€filing€their€ownÏapplication€seeking€approval€of€compensation.€€The€trusteeððs€application€can€be€approved€as€part€of€the€orderÏcreating€the€trustee€(see€optional€language€(òò[italicized€and€bracketed]óó)€in€Appendix€F)€or€by€separate€orderÐ Ô $ Ð(see€Appendix€G).ò òÐ ¦ ö  ÐÌà@--%ìàNO.€______ˆÌÌ__________________________,€ASà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFÐh È(#È(# ÐGUARDIAN€AD€LITEM€FOR€à@¿¿*ìàððˆÐ è8  Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà È à€€€€Ð¸ p(#p(# Ðòò[A€MINOR]óó€òò[AN€INCAPACITATED€PERSON]óó,à@¿¿*ìàððˆÐ ˆØ  Ðà0  àà0` (#(#àà0¸ ` (#` (#àPlaintiff,à@¿¿*ì¸ (#¸ (#àððˆÐ Zª  Ðà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð *z ÐTEXAS,Ð È(#È(# Ðv.à@¿¿*ìàððˆÐ Ê Ðà@¿¿*ìàððˆÌ__________________________,à@¿¿*ìàððˆÐ jº Ðà0  àà0` (#(#àà0¸ ` (#` (#àDefendantà@¿¿*ì¸ (#¸ (#àððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTó óÐ:ŠÈ(#È(# ÐÌà@$ $ ìàò òòòTRUSTEEððS€APPLICATION€óóà@@  ìàòòFOR€APPROVAL€OF€COMPENSATIONóóó óˆÐ Ü, ÐÌà  à____________€(ð ðTrusteeðð),€a€òò[national€banking€association€with€trust€powers][a€state€bankingÐ ~Î Ðassociation€with€trust€powers][a€Texas€trust€company],€óówhich€has€agreed€to€serve€as€trustee€of€a€trust€benefittingÐ P  Ð_______________€(ð ðPlaintiffðð)€which€this€court€is€creating€pursuant€to€Section€142.005€of€the€Texas€PropertyÏCode,€makes€this€application€to€the€court€for€approval€of€its€compensation€as€trustee€pursuant€to€Tex.€Prop.€CodeÏðð€142.005€(b)€(6).€€In€support€of€this€application,€Trustee€would€show€the€Court€as€follows:ÌÌà  àSection€142.005€(b)€(6)€of€the€Texas€Property€Code€provides€that€the€trustee€of€a€trust€created€pursuantÏto€Tex.€Prop.€Code€ðð€142.005€shall€receive€reasonable€compensation€paid€from€the€trustððs€income,€principal,€orÏboth€on€application€to€and€approval€of€the€Court.€€Trustee€makes€this€application€in€accordance€therewith€andÏasks€the€Court€to€approve€the€fees€and€compensation€that€are€payable€to€Trustee€under€the€terms€of€the€trustÏinstrument€approved€by€the€Court.ÌÌà@ŽŽ'ìàPRAYERˆÌÌà  àTrustee€prays€that€the€Court€will€approve€this€application€and€approve€the€fees€and€compensation€to€beÏpaid€to€Trustee€under€the€terms€of€the€trust€instrument€approved€by€the€Court.ÌÌRespectfully€submitted,ÌÌATTORNEYS€FOR€TRUSTEEÐ  *d%- ÐÔ_Ôà@‘ ‘ ìàò òÔ  ÔAPPENDIX€F€„„€Order€Creating€142€TrustÔ ˆ*Ôó óÔ €Ù ԈР° ÐÌò òà@--%ìàNO.€______ˆÐ R¢ ÐÌ__________________________,€ASà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFÐòBÈ(#È(# ÐGUARDIAN€AD€LITEM€FOR€à@¿¿*ìàððˆÐ  Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà È à€€€€Ð’ âp(#p(# Ðòò[A€MINOR]óó€òò[AN€INCAPACITATED€PERSON]óó,à@¿¿*ìàððˆÐ b ² Ðà0  àà0` (#(#àà0¸ ` (#` (#àPlaintiff,à@¿¿*ì¸ (#¸ (#àððˆÐ 4 „ Ðà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð  T  ÐTEXAS,Ð È(#È(# Ðv.à@¿¿*ìàððˆÐ ¤ ô  Ðà@¿¿*ìàððˆÌ__________________________,à@¿¿*ìàððˆÐ D”  Ðà0  àà0` (#(#àà0¸ ` (#` (#àDefendantà@¿¿*ì¸ (#¸ (#àððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTó óÐd È(#È(# ÐÌà@{{ ìàò òòòORDER€CREATING€TRUSTˆÐ ¶  Ðóóà@! ! ìàòòUNDER€SECTION€142.005€OF€THE€TEXAS€PROPERTY€CODEó óóóˆÐ †Ö  ÐÌà  àOn€this€day€the€Court€considered€the€Application€to€Create€Trust€Under€Section€142.005€of€the€TexasÏProperty€Code€(the€"Application")€filed€in€this€proceeding€by€____________€("Guardian€Ad€Litem"),€guardianÏad€litem€for€_____________€("Plaintiff"),€a€òò[minor]€[incapacitated€person€under€Tex.€Prop.€Code€ðð142.007]óó.€Ð Ì ÐBased€upon€the€Application,€the€pleadings€of€the€parties€in€this€proceeding,€the€evidence€presented€and€theÏargument€of€counsel,€the€Court€finds€that:ÌÌà  àÔ2#1ÔÚ  Ú1Ú  Ú.Ô3  Ôà ` àPlaintiff€is€entitled€to€judgment€in€the€above€entitled€and€numbered€cause.Ð d ÐÌØ€JØà  à2.à ` àPlaintiff€is€òò[a€minor]€[a€person€who€is€impaired€because€of€mental€illness,€mental€deficiency,Ð ¸ Ðphysical€illness€or€disability,€advanced€age,€chronic€use€of€drugs,€chronic€intoxication,€or€other€cause€to€theÏextent€that€Plaintiff€lacks€sufficient€understanding€or€capacity€to€make€or€communicate€responsible€decisionsÏconcerning€Plaintiff's€person]óó.Ð .~ ÐÌØ€JØÝ‚u;NÿÝÝ  Ýà  àÝ‚u;Nx4ÝÚƒJÚ3Ú  Ú.à0 ` àÝ  ÝPlaintiff€has€no€legal€guardian.݃u;Nx4Ÿ4ÝÛ€JÛŒÐÒ" ` (#` (# ÐŒÝ  ÝÌà  à4.à ` àCreation€of€a€trust€pursuant€to€Tex.€Prop.€Code€ðð142.005€containing€the€terms€and€provisionsÐ v Æ" Ðof€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€would€be€in€the€best€interests€ofÏPlaintiff.ÌÌÔ*eƒF4|dd¤dd ¤Œ•4°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  ¾#& Ðà@  ‚àò òOPTIONAL€SUPPLEMENTAL€NEEDS€TRUST€PROVISION:ó óˆÐ "$r' ÐÌØ€JØà l à5.€€It€would€be€in€the€best€interests€of€Plaintiff€for€the€trust€to€be€a€special€needs€trust€as€specifiedÏunder€42€U.S.C.€Section€1396p(d)(4)(A).ÌÌØ€JØà l à6.à Ä àThe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€areÐ :(Š#, Ðnecessary€to€establish€a€special€needs€trust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A).Ð  )\$- ÐÌà  à5.òò[7.]óóà ` à______________€("Trustee")€is€a€trust€company€or€a€state€or€national€bank€having€trust€powersÐ à*0&. Ðin€Texas€and€is€willing€to€serve€as€trustee€of€the€trust€for€Plaintiff's€benefit.ÌÌà  à6.òò[8.]óóà ` àòò[Trustee€has€filed€an€application€with€this€court€for€approval€of€its€fees€and€compensation.€€TheÐ V-¦(1 Ðcourt€finds€that€the€Trusteeððs€application€should€be€granted.]€€óóThe€fees€and€compensation€that€are€payable€toÐ ° ÐTrustee€under€the€terms€of€the€trust€instrument€are€reasonable€and€should€be€approved€by€the€Court.ÌÌà  à7.òò[9.]óóà ` àThat€the€clerk€of€this€Court€and/or€all€parties€to€this€proceeding€holding€funds€which€are€payableÐ &v Ðto€or€for€the€benefit€of€Plaintiff€should€be€ordered€to€pay€and€deliver€such€funds€to€Trustee€as€part€of€the€trustÏestate€of€such€trust.€òò[Modify€as€needed€to€fit€settlement/judgment€terms.]óóà È àÐ Ê ÐÌØ€JØà  à7.òò[10.]óóà ` àUpon€entry€of€judgment€and€creation€of€the€trust,€Guardian€Ad€Litem€should€be€paid€aÐ n ¾ Ðreasonable€fee€for€services€rendered,€should€be€reimbursed€for€expenses,€and€should€be€discharged€as€guardianÏad€litem€for€Plaintiff.ÌÌà  àIT€IS,€THEREFORE,€ORDERED€that€a€trust€for€the€benefit€of€Plaintiff€under€Tex.€Prop.€Code€ðð€142.005Ïis€hereby€created€with€those€terms€and€provisions€set€forth€in€Exhibit€"A"€attached€hereto€and€incorporatedÏherein;€that€Trustee€shall€be€trustee€of€such€trust;€òò[that€the€trust€shall€be€a€special€needs€trust€as€specified€underÐ Zª  Ð42€U.S.C.€Section€1396p(d)(4)(A);]óó€that€the€clerk€of€this€Court€and/or€any€party€to€this€proceeding€holding€fundsÐ ,|  Ðwhich€are€payable€to€or€for€the€benefit€of€Plaintiff€are€ordered€to€pay€and€deliver€such€funds€to€Trustee€as€partÏof€the€trust€estate€of€such€trust;€that€the€fees€and€compensation€authorized€to€be€paid€to€Trustee€by€the€terms€ofÏthe€trust€instrument€are€reasonable€and€are€approved€by€the€Court,€and€the€Trustee€is€authorized€to€pay€itself€suchÏfees€and€compensation€and€reimburse€itself€for€expenses€as€provided€in€the€trust€instrument€without€furtherÏapplication€to€or€order€from€this€Court;€that€Guardian€Ad€Litem€is€awarded€a€fee€of€$_______,€to€be€paid€byÏTrustee€upon€funding€of€the€trust€(if€not€sooner€paid);€and€that€Guardian€Ad€Litem€is€hereby€discharged,€willÏbe€paid€a€reasonable€fee,€be€reimbursed€for€costs,€and€be€discharged.ÌÌà  àSigned€this€____€day€of€_______________,€199__.ÌÌ_____________________________________ÌJudge€PresidingÐ  T Ðà@ ìàò òÔ  ÔAPPENDIX€G€„„€Order€Approving€Trusteeððs€CompensationÔ ßCÔó óÔ €Ú ԈР° ÐÌÔ*eƒŸ4 dd¤dd ¤F4|°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  R¢ ÐNote:€€Use€this€Order€only€if€the€trusteeððs€application€for€compensation€was€not€approved€in€the€order€creatingÏthe€trust€(see€Appendix€F€and€note€to€Appendix€E)ò ò.Ð ˆØ ÐÌà@--%ìàNO.€______ˆÌÌ__________________________,€ASà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFÐü LÈ(#È(# ÐGUARDIAN€AD€LITEM€FOR€à@¿¿*ìàððˆÐ Ì  Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà È à€€€€Ðœ ì p(#p(# Ðòò[A€MINOR]óó€òò[AN€INCAPACITATED€PERSON]óó,à@¿¿*ìàððˆÐ l ¼  Ðà0  àà0` (#(#àà0¸ ` (#` (#àPlaintiff,à@¿¿*ì¸ (#¸ (#àððˆÐ >Ž  Ðà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð ^  ÐTEXAS,Ð È(#È(# Ðv.à@¿¿*ìàððˆÐ ®þ  Ðà@¿¿*ìàððˆÌ__________________________,à@¿¿*ìàððˆÐ Nž  Ðà0  àà0` (#(#àà0¸ ` (#` (#àDefendantà@¿¿*ì¸ (#¸ (#àððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTó óÐnÈ(#È(# ÐÌà@† † ìàò òòòORDER€APPROVING€TRUSTEEððS€COMPENSATIONó óóóˆÐ À ÐÌà  àOn€this€day€the€Court€considered€the€Trusteeððs€Application€for€Approval€of€Compensation€filed€byÏ________________€(ð ðTrusteeðð),€trustee€of€the€trust€benefitting€_____________€(ð ðPlaintiffðð)€being€created€byÏthis€Court€pursuant€to€Tex.€Prop.€Code€ðð€142.005.€€The€Court€finds€that€the€compensation€to€be€paid€to€TrusteeÏunder€the€trust€instrument€being€approved€by€the€Court€is€reasonable.ÌÌà  àIT€IS,€THEREFORE,€ORDERED€that€application€filed€by€Trustee€is€approved€and€that€the€CourtÏapproves€the€payment€of€fees€and€compensation€to€Trustee€as€provided€in€the€trust€instrument€being€approvedÏby€the€Court.ÌÌà  àSIGNED€this€____€day€of€______________________,€_____.ÌÌÌ__________________________________ÌJudge€PresidingÐ   !\" Ðà@ûûìàò òÔ  ÔAPPENDIX€H€„„€Application€to€Modify€Trust€Regarding€1997€LegislationÔ €Û ÔÔ tMÔó óˆÐ ° ÐÌÌÌò òà@--%ìàNO.€______ˆÐ öF ÐÌIN€RE€COURT„CREATED€TRUSTà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFЖ æÈ(#È(# ÐFOR€THE€BENEFIT€OF€à@¿¿*ìàððˆÐ f ¶ Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð 6 † ÐTEXAS,à0xÈ(#È(#àà0Ð x(#x(#àà0@Ð D(#D(#àÐ V Ð (#Ð (# Ðòò[A€MINOR]óóà@¿¿*ìàððˆÐ Ö &  Ѐòò[AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTà0@>"ÚÜ#ÚÜ#àà0@>": Ü#: Ü#àà @>" à€€€€Ð¨ ø È(#È(# ÐÌà@™™ìàAPPLICATION€TO€MODIFY€TRUST€à@@LL7ìàREGARDING€1997€LEGISLATIONó óˆÐ Jš  ÐÌà  à__________________€("Trustee"),€trustee€of€the€court„created€trust€("the€Trust")€described€below€forÏthe€benefit€of€_________________€("Beneficiary"),€òò[a€minor]€[an€incapacitated€person]óó,€pursuant€to€SectionÐ ¾  Ð142.005€of€the€Texas€Property€Code,€files€this€Application€to€Modify€Trust€Regarding€1997€Legislation€(theÏ"Application").€€In€support€of€this€Application,€Trustee€would€show€the€Court€as€follows:ÌÌØ€JØà  à1.à ` àBy€order€dated€____________,€19___€(the€"Creation€Order"),€this€Court€created€a€trust€(theÐ V Ð"Trust")€for€the€benefit€of€Beneficiary€pursuant€to€Section€142.005€of€the€Texas€Property€Code.€€Trustee€isÏtrustee€of€the€Trust.€€The€Trust€is€governed€by€the€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"Ïand€incorporated€herein.ÌÌØ€JØà  à2.€€At€the€time€of€creation€of€the€Trust,€this€Court€determined€that€it€was€in€the€best€interests€ofÏBeneficiary€for€the€Trust€to€qualify€as€a€"special€needs€trust"€under€42€U.S.C.€Section€1396p(d)(4)(A),€and€theÏCourt€ordered€that€the€trust€instrument€governing€the€Trust€should€contain€provisions€which€the€CourtÏdetermined€were€necessary€to€qualify€the€Trust€as€a€"special€needs€trust"€under€42€U.S.C.€SectionÏ1396p(d)(4)(A).ÌÌØ€JØà  à3.à ` à1997,€the€Texas€Legislature€enacted€SB€912€(Acts,€75òòthóó€Legislature,€Regular€Session,€ChapterÐ  \ Ð128),€which€added€subparagraph€(g)€to€Section€142.004€of€the€Texas€Property€Code,€which€reads€as€follows:ÌÌà8  àà ` àà ¸ à(òòg)Notwithstanding€any€other€provision€of€this€chapter,€if€the€court€finds€thatÐ ‚ Ò" Ðit€would€be€in€the€best€interests€of€the€minor€or€incapacitated€person€for€whom€a€trust€isÏcreated€under€this€section,€the€trust€may€contain€provisions€determined€by€the€court€to€beÏnecessary€to€establish€a€special€needs€trust€as€specified€under€42€U.S.C.€SectionÏ1396p(d)(4)(A).óóÐÊ#&Ð Ð  ÐÌØ€JØà  à4.à ` àWhile€the€Court€clearly€found€when€it€created€the€Trust€that€it€would€be€in€the€best€interests€ofÐ n%¾ ( ÐBeneficiary€to€be€a€special€needs€trust€and€that€the€provisions€of€the€trust€instrument€governing€the€Trust€wereÏnecessary€for€the€Trust€to€be€a€special€needs€trust,€Trustee€is€unclear€whether€or€not€subparagraph€(g)€appliesÏto€the€Trust€since€the€Trust€was€created€prior€to€September€1,€1997,€which€is€the€effective€date€of€SB€912.ÌÌØ€JØà  à5.à ` àSo€that€there€is€no€confusion€or€question€regarding€the€terms€and€conditions€of€the€Trust€andÐ ˆ)Ø$- Ðthe€applicability€of€Tex.€Prop.€Code€ðð€142.005(g)€to€the€Trust,€Trustee€asks€the€Court€to€modify€the€Trust€so€thatÏTex.€Prop.€Code€ðð€142.005(g),€as€added€by€SB€912,€clearly€applies€to€the€Trust.ÌÌÌÐ ¢-ò(2 Ðà@ŽŽ'ìàPRAYERˆÌÌà  àTrustee€prays€that€this€Application€will€be€granted;€that€the€Court€will€modify€the€Trust€so€that€Tex.ÏProp.€Code€ðð€142.005(g),€as€added€by€SB€912,€applies€to€the€Trust;€that€the€Court€reaffirm€its€findings€that€it€isÏin€the€best€interests€of€Beneficiary€for€the€Trust€to€be€a€special€needs€trust€as€specified€in€42€U.S.C.€SectionÏ1396p(d)(4)(A),€and€that€the€provisions€of€the€trust€instrument€governing€the€Trust€are€necessary€for€the€TrustÏto€be€a€special€needs€trust€as€specified€in€42€U.S.C.€Section€1396p(d)(4)(A);€and€that€the€Court€award€such€otherÏand€further€relief€to€which€Trustee€may€be€entitled.ÌÌRespectfully€submitted,ÌÌÌATTORNEY€FOR€TRUSTEEÐ  ˆØ  Ðà@× × ìàò òÔ  ÔAPPENDIX€I€„„€Order€Modifying€Trust€Regarding€1997€LegislationÔ ù_Ôó óÔ €Ü ԈР° ÐÌò òà@--%ìàNO.€______ˆÐ R¢ ÐÌIN€RE€COURT„CREATED€TRUSTà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFÐòBÈ(#È(# ÐFOR€THE€BENEFIT€OF€à@¿¿*ìàððˆÐ  Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð ’ â ÐTEXAS,à0xÈ(#È(#àà0Ð x(#x(#àà0@Ð D(#D(#àÐb ²Ð (#Ð (# Ðòò[A€MINOR]óóà@¿¿*ìàððˆÐ 2 ‚ Ѐòò[AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTà0@>"ÚÜ#ÚÜ#àà0@>": Ü#: Ü#àà @>" à€€€€Ð T È(#È(# ÐÌà@´ ´ ìàORDER€MODIFYING€TRUST€à@@LL7ìàREGARDING€1997€LEGISLATIONó óˆÐ ¦ ö  ÐÌà  àOn€this€day€the€Court€considered€the€Application€to€Modify€Trust€Regarding€1997€Legislation€(theÏ"Application")€filed€in€this€proceeding€by€_____________€("Trustee").€€Based€upon€the€Application,€theÏevidence€presented€and€the€argument€of€counsel,€the€Court€finds€that:ÌÌØ€JØà  à1.à ` àBy€order€dated€_______________,€19___€(the€"Creation€Order"),€this€Court€created€a€trust€(theÐ à  Ð"Trust")€for€the€benefit€of€_______________€("Beneficiary")€pursuant€to€Section€142.005€of€the€Texas€PropertyÏCode.ÌÌØ€JØà  à2.à ` àTrustee€is€trustee€of€the€Trust.Ð Ø( ÐÌØ€JØà  à3.à ` àThe€Trust€is€governed€by€the€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€andÐ |Ì Ðincorporated€herein.ÌÌØ€JØà  à4.à ` àAt€the€time€of€creation€of€the€Trust,€this€Court€determined€that€it€was€in€the€best€interests€ofÐ òB ÐBeneficiary€for€the€Trust€to€qualify€as€a€"special€needs€trust"€under€42€U.S.C.€Section€1396p(d)(4)(A),€and€theÏCourt€ordered€that€the€trust€instrument€governing€the€Trust€should€contain€provisions€which€the€CourtÏdetermined€were€necessary€to€qualify€the€Trust€as€a€"special€needs€trust"€under€42€U.S.C.€SectionÏ1396p(d)(4)(A).ÌÌØ€JØà  à5.à ` àIn€1997,€the€Texas€Legislature€enacted€SB€912€(Acts,€75òòthóó€Legislature,€Regular€Session,€ChapterÐ Þ.  Ð128),€which€added€subparagraph€(g)€to€Section€142.004€of€the€Texas€Property€Code,€which€reads€as€follows:ÌÌà8  àà ` àà ¸ à(òòg)Notwithstanding€any€other€provision€of€this€chapter,€if€the€court€finds€thatÐ T!¤# Ðit€would€be€in€the€best€interests€of€the€minor€or€incapacitated€person€for€whom€a€trust€isÏcreated€under€this€section,€the€trust€may€contain€provisions€determined€by€the€court€to€beÏnecessary€to€establish€a€special€needs€trust€as€specified€under€42€U.S.C.€SectionÏ1396p(d)(4)(A).óóМ$ì'Ð Ð  ÐÌØ€JØà  à6.à ` àThe€Trust€should€be€modified€so€that€there€is€no€confusion€or€question€that€Tex.€Prop.€Code€ððÐ @&!) Ð142.005(g),€as€added€by€SB€912,€clearly€applies€to€the€Trust.ÌÌà  àIT€IS,€THEREFORE,€ORDERED€that€the€Trust€is€hereby€modified€so€that€Tex.€Prop.€Code€ððÏ142.005(g),€as€added€by€SB€912,€applies€to€the€Trust;€and€that€the€Court€reaffirm€its€findings€that€it€is€in€the€bestÏinterests€of€Beneficiary€for€the€Trust€to€be€a€special€needs€trust€as€specified€in€42€U.S.C.€Section€1396p(d)(4)(A),Ïand€that€the€provisions€of€the€trust€instrument€governing€the€Trust€as€attached€hereto€as€Exhibit€"A"€andÏincorporated€herein€are€necessary€for€the€Trust€to€be€a€special€needs€trust€as€specified€in€42€U.S.C.€SectionÏ1396p(d)(4)(A).ÌÐ ¢-ò(2 Ðà  àSigned€this€____€day€of€_________________,€199__.ÌÌ________________________________________ÌJudge€PresidingÐ  &v Ðà@ìàò òÔ  ÔAPPENDIX€J€ð"ð€Form€of€142€TrustÔ  pÔó óÔ €Ý ԈР° ÐÌò òà@--%ìàNO.€______ˆÐ R¢ ÐÌ__________________________,€ASà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€DISTRICT€COURT€OFÐòBÈ(#È(# ÐGUARDIAN€AD€LITEM€FOR€à@¿¿*ìàððˆÐ  Ð________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà È à€€€€Ð’ âp(#p(# Ðòò[A€MINOR]óó€òò[AN€INCAPACITATED€PERSON]óó,à@¿¿*ìàððˆÐ b ² Ðà0  àà0` (#(#àà0¸ ` (#` (#àPlaintiff,à@¿¿*ì¸ (#¸ (#àððˆÐ 4 „ Ðà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð  T  ÐTEXAS,Ð È(#È(# Ðv.à@¿¿*ìàððˆÐ ¤ ô  Ðà@¿¿*ìàððˆÌ__________________________,à@¿¿*ìàððˆÐ D”  Ðà0  àà0` (#(#àà0¸ ` (#` (#àDefendantà@¿¿*ì¸ (#¸ (#àððˆà0  àà0p(#(#àà0Èp(#p(#à____€JUDICIAL€DISTRICTó óÐd È(#È(# ÐÌÌà@® ® ìàò òCOURT„CREATED€TRUST€FOR€_______________________ó óˆÐ ˆØ  ÐÌà  àThis€declaration€of€trust€creates€a€trust€(the€"Trust")€for€the€benefit€of€____________________€(theÏ"Beneficiary"),€òò[a€minor][an€incapacitated€person€(within€the€meaning€of€Tex.€Prop.€Code€ðð142.007)]óó€€withÐ üL Ð__________________€(the€"Trustee")€as€trustee.ÌÌà  àÔ2#1ÔÚ  ÚaÚ  Ú.Ô3  Ôà ` àò òAuthority€for€Creation.ó ó€€This€Trust€is€created€by€the€order€of€the€District€Court€ofÐ r Ð_____________€County,€Texas,€____€Judicial€District€(the€"Court")€in€Cause€No.€_________,€styledÏ___________________________,€as€Guardian€Ad€Litem€for€________________________,€òò[a€Minor][anÐ h ÐIncapacitated€Person]óó,€v.€________________________________,€pursuant€to€Tex.€Prop.€Code€ðð€142.005.Ð ê: ÐÌà  àÔ2#1ÔÚ  ÚbÚ  Ú.Ô3  Ôà ` àò òTransfer€to€Trust.ó óà h àThe€initial€trust€estate€of€the€Trust€shall€be€the€property€described€onÐ ŽÞ ÐSchedule€"A"€attached€hereto.€€Additional€property€acceptable€to€the€Trustee€may€be€transferred€to€the€TrustÏfrom€time€to€time€and€added€to€the€trust€estate.ÌÌà  àÔ2#1ÔÚ  ÚcÚ  Ú.Ô3  Ôà ` àò òDistributions€During€Term€of€Trust.ó ó€€The€Beneficiary€shall€be€the€sole€beneficiary€of€theÐ Ø(  ÐTrust.€€Prior€to€termination€of€the€Trust,€the€Trustee€may€disburse€that€amount€of€the€Trust's€principal,€income,Ïor€both€as€the€Trustee€in€its€sole€discretion€determines€to€be€reasonably€necessary€for€the€health,€education,Ïsupport,€or€maintenance€of€the€Beneficiary.€€Distributions,€payments,€uses,€and€applications€of€all€trust€fundsÏmay€be€made€to€the€legal€or€natural€guardian€of€the€Beneficiary€or€to€the€person€having€custody€of€theÏBeneficiary€or€may€be€made€directly€to€or€expended€for€the€benefit,€support,€or€maintenance€of€the€BeneficiaryÏwithout€the€intervention€of€any€legal€guardian€or€other€legal€representative€of€the€Beneficiary.€€The€income€ofÏthe€Trust€that€the€Trustee€does€not€disburse€or€under€this€section€must€be€added€to€the€principal€of€the€Trust.ÌÌà  àÔ2#1ÔÚ  ÚdÚ  Ú.Ô3  Ôà ` àò òTermination€of€Trust.ó ó€€The€Trust€will€terminate€on€the€earlier€of:€€(a)€the€€death€of€theÐ <&Œ!) ÐBeneficiary;€or€(b)€òò[on€the€Beneficiaryððs€twenty„fifth€(25th)€birthday][when€the€Beneficiary€regains€capacityÐ '`"* Ð(within€the€meaning€of€Tex.€Prop.€Code€ðð142.007].€€óóThe€Trust€also€may€be€terminated€in€whole€or€in€part€at€anyÐ â'2#+ Ðtime€by€order€of€the€Court.ÌÌà  àÔ2#1ÔÚ  ÚeÚ  Ú.Ô3  Ôà ` àò òDistribution€Upon€Termination€of€Trust.€€ó óUpon€termination€of€the€Trust,€the€trustee€shallÐ X*¨%. Ðdistribute€the€principal€and€any€undistributed€income€of€the€Trust€to€the€Beneficiary,€outright€and€free€of€trust,Ïor,€if€the€Beneficiary€is€then€deceased,€to€the€representative€of€the€deceased€Beneficiaryððs€estate.ÌÐ Ð, (1 ÐÔ*eƒ£4¤dd¤dd ¤Ÿ4 °(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  ° €€Ðà@  ‚àò òIf€This€is€a€(d)(4)(A)€trust,€use€the€following€alternative€paragraphs€c.,€d.€and€e.€insteadó óˆÐ d ÐÌà l àc.à Ä àò òDistributions€During€Term€of€Trust.ó ó€€The€following€provisions€shall€govern€distributionsÐ ¶ Ðfrom€the€Trust€during€the€term€of€this€Trust:ÌÌà l àà Ä à1.à  àò òPurpose€and€Intent.ó ó€€This€Trust€is€created€pursuant€to€42€U.€S.€C.€ðð1396p(d)(4)(A).€Ð . ~ ÐIt€is€intended€to€be€construed€and€administered€as€a€ð ðsupplemental€needsðð€trust€under€42€U.€S.€C.Ïðð1396p(d)(4)(A).€€Without€limiting€the€foregoing,€neither€the€corpus€of€the€Trust€nor€distributions€from€theÏTrust€shall€ever€cause€the€Beneficiary€to€be€disqualified€to€receive€those€public€benefits€or€assistance€under€aÏstate€or€federal€program€to€which€the€Beneficiary€then€may€be€entitled€but€for€the€existence€of€this€Trust€or€butÏfor€the€distributions€from€this€Trust.ÌÌà l àà Ä à2.à  àò òDistribution€Standard.ó ó€€During€the€term€of€this€Trust,€the€Trustee€shall€apply€forÐ î>  Ðthe€benefit€of€the€Beneficiary€those€amounts€of€the€principal€and/or€income€of€the€Trust€for€the€satisfaction€ofÏthe€Beneficiaryððs€supplemental€needs€(defined€below),€as€the€Trustee,€in€the€Trustee's€sole€and€absoluteÏdiscretion,€may€from€time€to€time€deem€appropriate,€subject€to€the€strict€limitations€set€out€in€this€instrument.€ÏAny€income€of€the€trust€not€distributed€shall€be€added€to€the€principal.€€Distributions,€payments,€uses,€andÏapplications€of€all€trust€funds€may€be€made€to€the€legal€or€natural€guardian€of€the€Beneficiary€or€to€the€personÏhaving€custody€of€the€Beneficiary€or€may€be€expended€directly€for€the€benefit€of€the€Beneficiary€without€theÏintervention€of€any€legal€guardian€or€other€legal€representative€of€the€Beneficiary.€€ÌÌà l àà Ä à3.à  àò òSupplemental€Needs.€€ó óAs€used€in€this€instrument,€"supplemental€needs"€refers€to€theÐ R¢ Ðrequisites,€as€allowed€for€in€42€U.€S.€C.€ðð1396p(d)(4)(A),€for€maintaining€the€Beneficiaryððs€health,€safety,€andÏwelfare€when€the€Trustee€determines,€in€its€discretion,€that€such€needs€are€not€being€provided€for€by€anyÏpublic€or€private€agency,€including€any€state,€the€United€States,€or€any€insurance€carrier€with€insuranceÏpolicies€covering€the€Beneficiary.€€The€Trustee€is€prohibited€from€expending€any€of€the€trust€principal€orÏincome€for€any€property,€services,€benefits,€or€medical€care€which€are€being€received€by,€or€which€areÏotherwise€available€to,€the€Beneficiary€from€any€governmental€source€or€from€any€insurance€carrier€requiredÏto€cover€the€Beneficiary.€€Further,€the€Trustee€is€prohibited€from€expending€any€of€the€trust€principal€orÏincome€for€any€such€property,€services,€benefits,€or€medical€care€if€that€restriction€is€necessary€in€order€toÏqualify€the€Beneficiary€for€such€governmental€or€insurance€carrier€benefits€because€an€application€for€suchÏproperty,€services,€benefits,€or€medical€care€has€been€filed€with€an€applicable€governmental€agency€orÏinsurance€carrier€on€the€Beneficiary's€behalf.€€The€Trustee€may€pay€any€deductible€amounts€for€theÏBeneficiary€on€any€insurance€policies€covering€the€Beneficiary€so€long€as€that€payment€does€not€disqualify€theÏBeneficiary€from€receipt€of€benefits.€€The€Trustee€shall€cooperate€with€the€Beneficiaryððs€conservator,Ïguardian,€or€legal€representative€to€seek€support€and€maintenance€for€the€Beneficiary€from€all€availableÏresources,€including€but€not€limited€to,€the€Supplemental€Social€Security€Income€Program€(SSI),ÏSupplemental€Income€Program€(SIP)€of€Texas,€the€Old€Age€Survivor€and€Disability€Insurance€ProgramÏ(OASDI),€the€Medicaid€Program,€and€any€additional€similar€or€successor€programs,€and€from€any€privateÏsources.€€To€the€extent€required€by€42€U.€S.€C.€ðð1396p(d)(4)(A)€and€other€applicable€laws€and€regulationsÏregarding€trusts€of€this€type,€the€Trustee€òòòòmay€supplement,€but€shall€not€supplantóó,óó€services,€benefits,€andÐ ê%:!) Ðmedical€care€received€or€requested€by€or€on€behalf€of€the€Beneficiary€that€are€available€through€anyÏgovernmental€or€private€resource.ÌÌà l àà Ä à4.à  àò òPayment€of€Income€Taxes.ó ó€€The€Trustee€shall€pay€any€income€tax€liability€of€theÐ 2)‚$- ÐBeneficiary€which€results€from€income€received€by€the€Trust€but€reported€on€the€income€tax€return€of€theÏBeneficiary.€€The€funds€used€to€pay€this€income€tax€liability€shall€be€paid€directly€to€the€appropriate€taxingÏauthority€and€shall€not€be€available€to€the€Beneficiary.€€The€Beneficiary€shall€not€have€any€right€to€or€interestÏin€any€of€these€funds€paid€by€the€Trustee.€€Further,€these€funds€are€not€a€resource€of€the€Beneficiary€and€shallÏnot€be€treated€as€a€distribution€of€cash€for€purposes€of€Medicaid€qualification.Ð N-ž(2 Їà l àd.à Ä àò òTermination€of€Trust.ó ó€€The€Trust€will€terminate€on€the€death€of€the€Beneficiary.€€The€TrustÐ d Ðalso€may€be€terminated€in€whole€or€in€part€at€any€time€by€order€of€the€Court.ÌÌà l àe.à Ä àò òDistribution€Upon€Termination€of€Trust.€€ó óUpon€termination€of€the€Trust,€the€trustee€shallÐ ŒÜ Ðdistribute€the€principal€and€any€undistributed€income€of€the€Trust€as€follows:Ìà l àÌà l àà Ä à1.à  àFirst,€the€Trustee€shall€pay€all€amounts€required€to€be€reimbursed€pursuant€to€42€U.Ð  T ÐS.€C.€ðð1396p(d)(4)(A).€€The€Trustee€shall€reimburse€those€states€where€the€Beneficiary€has€received€MedicalÏAssistance€payments€from€the€state,€based€upon€the€state's€proportionate€share€of€the€total€amount€of€MedicaidÏbenefits€paid€by€all€of€the€states€on€the€Beneficiaryððs€behalf,€the€smallest€amount€(if€any)€as€applicable€lawÏthen€requires€the€Trust€to€pay.€€The€Trustee's€duty€to€reimburse€the€state€upon€termination€shall€apply€to€theÏextent€there€are€remaining€assets€in€this€trust€and€shall€apply€irrespective€of€any€other€provision€of€thisÏinstrument.€€€The€Trustee€shall€reimburse€the€state€only€for€those€benefits€provided€to€the€Beneficiary€whichÏare€subject€to€such€reimbursement€claim.ÌÌà l àà Ä à2.à  àAfter€the€satisfaction€of€these€obligations,€the€Trustee€shall€distribute€the€remainingÐ f¶  Ðproperty,€if€any,€to€the€Beneficiary,€outright€and€free€of€trust,€or,€if€the€Beneficiary€is€then€deceased,€to€theÏrepresentative€of€the€deceased€Beneficiaryððs€estate.Ð Z  ÐÌà  àÔ2#1ÔÚ  ÚfÚ  Ú.Ô3  Ôà ` àò òCompensation€of€the€Trustee.ó ó€€The€Trustee€is€entitled€to€reasonable€compensation€paid€fromÐ Þ. Ðthe€Trustððs€income,€principal,€or€both€on€application€to€and€approval€of€the€Court.€€Unless€otherwise€ordered€byÏthe€Court,€the€fees€and€other€charges€described€on€the€Trusteeððs€then„current€fee€schedule€are€hereby€approvedÏby€the€Court€as€reasonable€compensation€to€the€Trustee,€and€the€Trustee€is€entitled€to€pay€itself€such€fees€andÏother€charges€without€further€application€to€or€approval€of€the€Court.€€In€addition,€the€Trustee€may€be€reimbursedÏfrom€the€trust€estate€for€expenses€it€reasonably€incurs€in€connection€with€the€Trust.ÌÌà  àÔ2#1ÔÚ  ÚgÚ  Ú.Ô3  Ôà ` àò òPowers€of€Trustee.ó ó€€The€Trustee€shall€have€all€of€the€powers€of€trustees€under€the€Texas€TrustÐ žî ÐCode.€€The€terms€and€provisions€of€the€Texas€Trust€Code€shall€apply€to€this€Trust,€to€the€extent€they€are€not€inÏconflict€with€Tex.€Prop.€Code€ðð€142.005€or€with€the€terms€of€this€instrument.ÌÌà  àÔ2#1ÔÚ  ÚhÚ  Ú.Ô3  Ôà ` àò òNo€Bond€Required.ó ó€€The€Trustee€shall€serve€without€giving€a€bond.€Ð è8 ÐÌà  àÔ2#1ÔÚ  ÚiÚ  Ú.Ô3  Ôà ` àò òSuccessor€Trustees.ó ó€€In€the€event€of€the€corporate€reorganization,€merger€or€acquisition€of€theÐ ŽÞ  ÐTrustee,€the€resulting€successor€organization€shall€automatically€become€the€successor€trustee.€€The€Trustee€mayÏresign€with€the€approval€of€the€Court€and€may€be€removed€by€order€of€the€Court.€€Upon€the€resignation€orÏremoval€of€the€Trustee,€the€Court€shall€appoint€a€successor€trustee.€€Each€successor€trustee€shall€have€all€of€theÏrights,€powers€and€duties€of€the€Trustee.ÌÌà  àÔ2#1 ÔÚ  ÚjÚ  Ú.Ô3  Ôà ` àò òSpendthrift€Trust.ó ó€€To€the€extent€permitted€by€law,€the€interest€of€the€Beneficiary€shall€be€heldÐ |$Ì& Ðsubject€to€a€spendthrift€trust€as€provided€in€Section€112.035€of€the€Texas€Property€Code.ÌÌà  àÔ2#1 ÔÚ  ÚkÚ  Ú.Ô3  Ôà ` àò òAmendment,€Modification€or€Revocation.ó ó€€The€Court€may€amend,€modify,€or€revoke€the€TrustÐ ô&D") Ðat€any€time€before€the€date€of€the€Trust's€termination.€€Neither€the€Beneficiary€nor€the€guardian€of€theÏBeneficiary's€estate€may€revoke€the€Trust.ÌÌà  àÔ2#1 ÔÚ  ÚlÚ  Ú.Ô3  Ôà ` àò òEffective€Date.ó ó€€€This€Trust€shall€be€effective€upon€the€last€to€occur€of€(A)€the€entry€of€an€orderÐ >*Ž%- Ðcreating€the€Trust€by€the€Court,€(B)€the€execution€of€this€Ô& b ÔDeclaration€of€Trust€by€the€Trustee€indicating€itsÏacceptance€of€the€Trust;€and€(C)€the€receipt€by€the€Trustee€of€the€initial€trust€estate.ÌÌTRUSTEE'S€ACCEPTANCE:ÌÌÌBy:_______________________ÌName:_____________________ÌTitle:______________________Ô'b°¾¦ÔÌÐ   b  Ðà@xxìàò òÔ  ÔAPPENDIX€K€ð"ð€Combined€Application€For€Guardianship€And€Creation€of€867€Trust€Where€NoˆÐ ° ÐGuardianship€ExistsÔ  ¨Ôó óÔ €Þ ÔÐ €Ð ÐÌÔ*eƒ)4©dd¤dd ¤£4¤°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  "r ÐOften€the€need€for€an€867€Trust€is€apparent€before€a€guardianship€is€in€place.€€In€these€cases,€it€makes€moreÏsense€to€proceed€directly€with€creation€of€an€867€Trust€without€the€appointment€and€qualification€of€aÏguardian.€€However,€prior€to€1997€only€a€guardian€could€apply€for€creation€of€an€867€Trust.€€Since€one€doesÏnot€become€a€guardian€until€one€is€appointed€and€qualifies,€appointment€of€a€guardian€was€a€prerequisite€toÏcreation€of€an€867€Trust.€€In€1997€Section€867€was€amended€to€permit€a€wardððs€attorney€ad€litem€ð ðòòat€any€timeÐ Î  Ðafter€the€date€of€the€attorneyððs€appointmentððóó€to€apply€for€creation€of€an€867€Trust€and€to€permit€the€court€toÐ   ð  Ðorder€third€parties€to€transfer€funds€directly€to€the€trustee€of€an€867€Trust€without€the€need€for€the€property€toÏpass€through€the€hands€of€a€guardian€of€the€estate.€€Thus,€now€an€applicant€can€try€to€convince€an€attorney€adÏlitem€to€apply€for€creation€of€an€867€Trust€before€a€guardian€is€appointed,€obviating€the€need€for€aÏguardianship.€€This€application€anticipates€that€an€attorney€ad€litem€will€be€appointed€who€can€be€convincedÏto€file€a€related€application€(see€Appendix€L)€for€creation€of€an€867€Trust.Ð º  ÐÌà@%ìàò òNO.€_______ˆÐ ŽÞ  ÐÌGUARDIANSHIP€OFà@¿¿*ìàððˆà0  àà0p(#(#àIN€THE€PROBATE€COURTÐ.~p(#p(# Ðà@¿¿*ìàððˆÌ_________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà0 È(#È(#àà0x (# (#àOFÐÎx(#x(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#à______________€COUNTY,€TEXASÐn¾p(#p(# ÐÌà@ ìàòòAPPLICATION€FOR€GUARDIANSHIP€AND/OR€CREATION€OF€GUARDIANSHIPˆÐ ` ÐMANAGEMENT€TRUSTóóó óÐ à0 ÐÌà  à______________€(ð ðApplicantðð)€files€this€application€for€the€appointment€of€a€guardian€and/or€forÏcreation€of€a€guardianship€management€trust€for€the€benefit€of€____________€(the€ð ðProposed€Wardðð),€òò[aÐ T¤ Ðminor][an€incapacitated€person],óó€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867.€€In€support€of€this€application,Ð &v ÐApplicant€would€show€the€Court€as€follows:ÌÌà  à1.à ` àThe€Proposed€Ward€is€òò[a€minor][an€incapacitated€person].óó€€The€Proposed€Wardððs€name,€sex,Ð œì Ðdate€of€birth€and€address€are€as€follows:_______________.ÌÌà  à2.à ` àApplicantððs€name,€address€and€relationship€to€the€Proposed€Ward€are€as€follows:€__________.Ð !b" ÐÌà  à3.à ` àApplicant€is€seeking€the€creation€of€a€guardianship€management€trust€pursuant€to€Tex.€Prob.Ð ¶"$ ÐCode€Ann.€ðð867.€€Only€if€required€by€the€Court€for€creation€of€a€guardianship€management€trust,€or,Ïalternatively,€only€if€the€Court€refuses€to€create€a€guardianship€management€trust,€Applicant€seeks€theÏappointment€of€a€guardian€of€the€estate€and€person€of€the€Proposed€Ward.ÌÌà  à4.à ` àThe€nature€and€degree€of€the€Proposed€Wardððs€incapacity,€the€specific€areas€of€protection€andÐ Ð& ") Ðassistance€requested,€and€the€limitation€of€rights€requested€to€be€included€in€the€Courtððs€order€are€asÏfollows:___________________.ÌÌà  à5.à ` àThe€facts€requiring€the€guardianship€management€trust€to€be€created€and€the€interest€ofÐ *h%- ÐApplicant€in€such€creation€are€as€follows:€The€Proposed€Ward€needs€the€assistance€of€a€trustee€in€managing€theÏProposed€Wardððs€estate.€€Creation€of€a€guardianship€management€trust,€rather€than€a€guardianship€of€the€estate,Ïis€in€the€best€interests€of€the€Proposed€Ward.€€Applicant€believes€that€creation€of€a€guardianship€managementÏtrust€is€in€the€Proposed€Wardððs€best€interests.€òò[Add€more€facts€as€desired€or€appropriate.]óóÐ `-°(1 Їà  à6.à ` àNo€guardianship€exists€for€the€Proposed€Ward,€to€the€knowledge€of€Applicant.Ð ° ÐÌà  à7.€€The€name€and€address€of€any€person€or€institution€having€the€care€and€custody€of€the€Proposed€WardÏis€as€follows:_______________.ÌÌà  à8.à ` àThe€approximate€value€and€description€of€the€Proposed€Wardððs€property,€including€anyÐ Ê Ðcompensation,€pension,€insurance,€or€allowance€to€which€the€Proposed€Ward€may€be€entitled,€to€the€knowledgeÏof€Applicant,€is€as€follows:_______________.ÌÌà  à9.à ` àThe€requested€term€of€the€guardianship€management€trust€is€as€stated€in€the€proposed€form€ofÐ  b  Ðthe€trust€attached€hereto€as€Exhibit€ð ðAðð€and€incorporated€herein.ÌÌà  à10.à ` àThe€name€and€address€of€any€person€whom€the€applicant€knows€to€hold€a€power€of€attorneyÐ ˆØ  Ðsigned€by€the€Proposed€Ward€and€a€description€of€the€type€of€power€of€attorney€is€as€follows:___________.ÌÌà  à11.à ` àòò[If€the€Proposed€Ward€is€a€minor,€include€the€names€of€the€parents€and€next€of€kin€of€theÐ þN  ÐProposed€Ward€and€a€statement€as€to€whether€either€or€both€of€the€parents€are€deceased.]óóÐ Ð  ÐÌà  à12.à ` àòò[If€the€Proposed€Ward€is€a€minor,€include€a€statement€as€to€whether€the€minor€was€the€subjectÐ tÄ Ðof€a€legal€or€conservatorship€proceeding€within€the€preceding€two„year€period€and,€if€so,€the€court€involved,Ïthe€nature€of€the€proceeding,€and€the€final€disposition,€if€any,€of€the€proceeding.]óóÐ h ÐÌà  à13.à ` àòò[If€the€Proposed€Ward€is€60€years€of€age€or€older,€include€the€names€and€addresses,€to€the€bestÐ ¼  Ðof€Applicantððs€knowledge,€of€the€Proposed€Wardððs€spouse,€siblings,€and€children,€or,€if€there€is€no€spouse,Ïsibling,€or€child,€the€names€and€addresses€of€the€Proposed€Wardððs€next€of€kin.]óóÐ `° ÐÌà  à14.à ` àThis€Court€has€venue€over€this€proceeding€because€the€Proposed€Ward€is€a€resident€of€and€isÐ T Ðdomiciled€in€______________€County,€Texas.ÌÌà  à15.à ` àCreation€of€a€guardianship€management€trust€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867€containingÐ zÊ Ðthe€terms€and€provisions€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€wouldÏbe€in€the€best€interests€of€the€Proposed€Ward.€€òò[If€desired,€state€the€reasons€for€creation€of€the€867€Trust.]óóÐ n ÐÌÔ*eƒ84}dd¤dd ¤)4©°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  Â! Ðà@ä ä ‚àò òOPTIONAL€SUPPLEMENTAL€NEEDS€TRUST€PROVISIONS:ó óˆÐ & v" ÐÌØ€JØà l à16.à Ä àIt€would€be€in€the€best€interests€of€the€Proposed€Ward€for€the€trust€to€be€a€supplemental€needsÐ È!$ Ðtrust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A).ÌÌØ€JØà l à17.à Ä àThe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€areÐ >$Ž' Ðnecessary€and€appropriate€for€the€Proposed€Ward€to€be€eligible€to€receive€public€benefits€or€assistance€under€aÏstate€or€federal€program€that€is€not€otherwise€available€to€the€Proposed€Ward.Ð â%2!) ÐÌà  à18.à ` à_________________€("Trustee")€is€a€trust€company€or€a€state€or€national€bank€having€trustÐ ¶'#* Ðpowers€in€Texas€and€is€willing€to€serve€as€trustee€of€the€guardianship€management€trust€for€the€Proposed€WardððsÏbenefit.ÌÌà  à19.à ` àThe€Court€should€direct€that,€upon€creation€of€the€guardianship€management€trust,€each€personÐ þ*N&. Ðholding€property€of€the€Proposed€Ward€òò[including,€but€not€limited€to,€____________________€(specificallyÐ Ð+ '/ Ðidentify€third€parties€holding€the€Proposed€Wardððs€funds)]óó€shall€deliver€all€of€such€assets€to€Trustee,€to€be€heldÐ ¢,ò'0 Ðby€Trustee€as€the€trust€estate€of€the€trust.Ð t-Ä(1 Їà  à20.à ` àNo€guardianship€of€the€Proposed€Wardððs€person€or€estate€is€necessary,€and€the€Court€shouldÐ ° Ðorder€than€none€be€created.€€However,€if€the€Court€refuses€to€create€a€guardianship€management€trust€for€theÏWard,€or,€alternatively,€if€the€Court€requires€the€appointment€of€a€guardian€of€the€estate€and/or€guardian€of€theÏperson€of€the€Proposed€Ward€as€a€condition€to€the€creation€of€the€guardianship€management€trust,€Applicant€asksÏthat€________________€(the€ð ðProposed€Guardianðð)€be€appointed€the€guardian€of€the€estate€and/or€guardian€ofÏthe€person€of€the€Proposed€Ward.€€The€Proposed€Guardian€is€qualified€and€is€not€disqualified€to€serve€asÏguardian€of€the€person€and/or€estate€of€the€Proposed€Ward.ÌÌà@ŽŽ'ìàPRAYERˆÌÌà  àApplicant€prays€that,€after€proper€notice€and€service€of€citation,€the€Court€will€appoint€an€attorney€adÏlitem€for€the€Proposed€Ward;€that€the€Court€will€make€the€findings€and€determinations€described€above€andÏnecessary€for€the€creation€of€a€guardianship€management€trust€for€the€benefit€of€the€Proposed€Ward;€that€theÏCourt€will€create€a€guardianship€management€trust€for€the€benefit€of€the€Proposed€Ward€pursuant€to€Tex.€Prob.ÏCode€Ann.€ðð867€with€those€terms€and€provisions€set€forth€in€Exhibit€"A"€attached€hereto€and€incorporatedÏherein;€that€the€Court€will€name€Trustee€as€trustee€of€such€trust;€òò[that€the€trust€shall€be€a€supplemental€needsÐ þN  Ðtrust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A);]óó€that€the€Court€will€order€each€person€holdingÐ Ð  Ðproperty€of€the€Proposed€Ward€to€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estateÏof€the€trust;€that€the€Court€will€find€that€no€guardianship€of€the€estate€and/or€person€of€the€Proposed€Ward€isÏnecessary,€or,€alternatively,€that€the€Court€will€appoint€the€Proposed€Guardian€as€guardian€of€the€person€and/orÏestate€of€the€Proposed€Ward;€and€that€the€Court€will€grant€such€other€and€further€relief€to€which€Plaintiff€mayÏbe€entitled.ÌÌRespectfully€submitted,ÌÌATTORNEY€FOR€APPLICANTà h àÐ  2‚ Ðà@œœìàò òÔ  ÔAPPENDIX€L€ð"ð€Attorney€Ad€Litemððs€Application€to€Create€867€Trust€Where€No€GuardianshipˆÐ ° ÐExistsÔ ÑÑÔó óÔ €ß ÔÐ €Ð ÐÌÔ*eƒ¬4­dd¤dd ¤84}°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  "r ÐThis€form€may€be€used€by€an€attorney€ad€litem€to€apply€for€creation€of€an€867€Trust€before€a€guardian€isÏappointed.€€It€may€be€used€in€conjunction€with€Appendix€K,€in€cases€where€the€applicant€for€the€guardianshipÏalso€wants€an€867€Trust€to€be€created,€or€it€may€be€used€by€itself€in€cases€where€the€applicant€did€not€seekÏcreation€of€an€867€Trust.Ð ü L ÐÌà@%ìàò òNO.€_______ˆÐ Ð  ÐÌGUARDIANSHIP€OFà@¿¿*ìàððˆà0  àà0p(#(#àIN€THE€PROBATE€COURTÐp À p(#p(# Ðà@¿¿*ìàððˆÌ_________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà0 È(#È(#àà0x (# (#àOFÐ` x(#x(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#à______________€COUNTY,€TEXASа p(#p(# ÐÌà@kkìàòòAPPLICATION€FOR€CREATION€OF€GUARDIANSHIP€MANAGEMENT€TRUSTóóó óˆÐ R¢  ÐÌà  à________________________€(ð ðApplicantðð),€attorney€ad€litem€for€_____________________€(theÏð ðProposed€Wardðð),€òò[a€minor][an€incapacitated€person],óó€files€this€application€for€the€creation€of€a€guardianshipÐ Æ Ðmanagement€trust€for€the€benefit€of€the€Proposed€Ward€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867.€€In€support€ofÏthis€application,€Applicant€would€show€the€Court€as€follows:ÌÌà  à1.à ` àThe€Proposed€Ward€is€òò[a€minor][an€incapacitated€person].óó€€The€Proposed€Wardððs€name,€sex,Ð ^ Ðdate€of€birth€and€address€are€as€follows:_________________.ÌÌà  à2.à ` àApplicant€is€the€court„appointed€attorney€ad€litem€for€the€Proposed€Ward.€€Applicantððs€nameÐ „Ô Ðand€address€are€as€follows:_________________.ÌÌà  à3.à ` àApplicant€seeks€neither€a€guardianship€of€the€person€or€estate€of€the€Proposed€Ward;€rather,Ð úJ ÐApplicant€seeks€the€creation€of€a€guardianship€management€trust€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867.ÌÌà  à4.à ` àThe€nature€and€degree€of€the€Proposed€Wardððs€incapacity,€the€specific€areas€of€protection€andÐ pÀ  Ðassistance€requested,€and€the€limitation€of€rights€requested€to€be€included€in€the€Courtððs€order€are€asÏfollows:_____________.ÌÌà  à5.à ` àThe€facts€requiring€the€guardianship€management€trust€to€be€created€and€the€interest€ofÐ ¸"$ ÐApplicant€in€such€creation€are€as€follows:€The€Proposed€Ward€needs€the€assistance€of€a€trustee€in€managing€theÏProposed€Wardððs€estate.€€Creation€of€a€guardianship€management€trust,€rather€than€a€guardianship€of€the€estate,Ïis€in€the€best€interests€of€the€Proposed€Ward.€€Applicant€is€the€court„appointed€attorney€ad€litem€for€the€ProposedÏWard€and€believes€that€creation€of€a€guardianship€management€trust€is€in€the€Proposed€Wardððs€best€interests.Ð &P!( Ðòò[Add€more€facts€as€desired€or€appropriate.]óóÐ Ò&"") ÐÌà  à6.à ` àNo€guardianship€exists€for€the€Proposed€Ward,€to€the€knowledge€of€Applicant.€_____________Ð v(Æ#+ Ðhas€filed€an€application€for€appointment€of€a€guardian,€and€that€application€is€pending€in€this€Court€under€thisÏcause€number.€òò[If€accurate:€_________________€consents€to€the€creation€of€a€guardianship€management€trustÐ *j%- Ðin€lieu€of€a€guardianship€of€the€estate€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867.]óóÐ ì*<&. ÐÌà  à7.€€The€name€and€address€of€any€person€or€institution€having€the€care€and€custody€of€the€Proposed€WardÏis€as€follows:________________.Ð b-²(1 Їà  à8.à ` àThe€approximate€value€and€description€of€the€Proposed€Wardððs€property,€including€anyÐ ° Ðcompensation,€pension,€insurance,€or€allowance€to€which€the€Proposed€Ward€may€be€entitled,€to€the€knowledgeÏof€Applicant,€is€as€follows:_____________.ÌÌà  à9.à ` àThe€requested€term€of€the€guardianship€management€trust€is€as€stated€in€the€proposed€form€ofÐ øH Ðthe€trust€attached€hereto€as€Exhibit€ð ðAðð€and€incorporated€herein.ÌÌà  à10.à ` àThe€name€and€address€of€any€person€whom€the€applicant€knows€to€hold€a€power€of€attorneyÐ n ¾ Ðsigned€by€the€Proposed€Ward€and€a€description€of€the€type€of€power€of€attorney€is€as€follows:___________.ÌÌà  à11.à ` àòò[If€the€Proposed€Ward€is€a€minor,€include€the€names€of€the€parents€and€next€of€kin€of€theÐ ä 4  ÐProposed€Ward€and€a€statement€as€to€whether€either€or€both€of€the€parents€are€deceased.]óóÐ ¶   ÐÌà  à12.à ` àòò[If€the€Proposed€Ward€is€a€minor,€include€a€statement€as€to€whether€the€minor€was€the€subjectÐ Zª  Ðof€a€legal€or€conservatorship€proceeding€within€the€preceding€two„year€period€and,€if€so,€the€court€involved,Ïthe€nature€of€the€proceeding,€and€the€final€disposition,€if€any,€of€the€proceeding.]óóÐ þN  ÐÌà  à13.à ` àòò[If€the€Proposed€Ward€is€60€years€of€age€or€older,€include€the€names€and€addresses,€to€the€bestÐ ¢ò  Ðof€Applicantððs€knowledge,€of€the€Proposed€Wardððs€spouse,€siblings,€and€children,€or,€if€there€is€no€spouse,Ïsibling,€or€child,€the€names€and€addresses€of€the€Proposed€Wardððs€next€of€kin.]óóÐ F– ÐÌà  à14.à ` àThis€Court€has€venue€over€this€proceeding€because€the€Proposed€Ward€is€a€resident€of€and€isÐ ê: Ðdomiciled€in€______________€County,€Texas.ÌÌà  à15.à ` àCreation€of€a€guardianship€management€trust€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867€containingÐ `° Ðthe€terms€and€provisions€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€wouldÏbe€in€the€best€interests€of€the€Proposed€Ward.€€òò[If€desired,€state€the€reasons€for€creation€of€the€867€Trust.]óóÐ T ÐÌÔ*eƒ;4Add¤dd ¤¬4­°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  ¨ø Ðà@ä ä ‚àò òOPTIONAL€SUPPLEMENTAL€NEEDS€TRUST€PROVISIONS:ó óˆÐ  \ ÐÌØ€JØà l à16.à Ä àIt€would€be€in€the€best€interests€of€the€Proposed€Ward€for€the€trust€to€be€a€supplemental€needsÐ ®þ Ðtrust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A).ÌÌØ€JØà l à17.à Ä àThe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€areÐ $ t" Ðnecessary€and€appropriate€for€the€Proposed€Ward€to€be€eligible€to€receive€public€benefits€or€assistance€under€aÏstate€or€federal€program€that€is€not€otherwise€available€to€the€Proposed€Ward.Ð È!$ ÐÌà  à18.à ` à_______________€("Trustee")€is€a€trust€company€or€a€state€or€national€bank€having€trust€powersÐ œ#ì% Ðin€Texas€and€is€willing€to€serve€as€trustee€of€the€guardianship€management€trust€for€the€Proposed€Wardððs€benefit.ÌÌà  à19.à ` àThe€Court€should€direct€that,€upon€creation€of€the€guardianship€management€trust,€each€personÐ &b!( Ðholding€property€of€the€Proposed€Ward€òò[including,€but€not€limited€to,€_____________€(specifically€identify€thirdÐ ä&4") Ðparties€holding€the€Proposed€Wardððs€funds)]óó€shall€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€TrusteeÐ ¶'#* Ðas€the€trust€estate€of€the€trust.ÌÌà  à20.à ` àNo€guardianship€of€the€Proposed€Wardððs€estate€is€necessary.Ð ,*|%- ÐÌà  à21.à ` àòò[If€desired:€No€guardianship€of€the€Proposed€Wardððs€person€is€necessary.]óóÐ Ð+ '/ ÐÌà  à22.à ` àUpon€entry€of€the€Courtððs€order€creating€the€guardianship€management€trust,€Applicant,€attorneyÐ t-Ä(1 Ðad€litem€for€the€Proposed€Ward,€should€be€paid€a€reasonable€fee€from€the€trust€and€should€be€discharged.ÌÌà@ŽŽ'ìàPRAYERˆÌÌà  àApplicant€prays€that€the€Court€will€make€the€findings€and€determinations€described€above€and€necessaryÏfor€the€creation€of€a€guardianship€management€trust€for€the€benefit€of€the€Proposed€Ward;€that€the€Court€willÏcreate€a€guardianship€management€trust€for€the€benefit€of€the€Proposed€Ward€pursuant€to€Tex.€Prob.€Code€Ann.Ïðð867€with€those€terms€and€provisions€set€forth€in€Exhibit€"A"€attached€hereto€and€incorporated€herein;€that€theÏCourt€will€name€Trustee€as€trustee€of€such€trust;€òò[that€the€trust€shall€be€a€supplemental€needs€trust€as€specifiedÐ @  Ðunder€42€U.S.C.€Section€1396p(d)(4)(A);]óó€that€the€Court€will€order€each€person€holding€property€of€the€ProposedÐ  b  ÐWard€to€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estate€of€the€trust;€that€the€CourtÏwill€award€Applicant€a€reasonable€fee€as€attorney€ad€litem,€to€be€paid€by€Trustee€upon€funding€of€the€trust€(ifÏnot€sooner€paid);€that€the€Court€will€discharge€Applicant€as€attorney€ad€litem;€and€that€the€Court€will€grant€suchÏother€and€further€relief€to€which€Plaintiff€may€be€entitled.ÌÌRespectfully€submitted,ÌÌATTORNEY€AD€LITEMÐ  ¢ò  Ðà@šš ìàò òÔ  ÔAPPENDIX€M€ð"ð€Order€Creating€867€Trust€Where€No€Guardianship€ExistsÔ Œ÷Ôó óÔ €à ԈР° ÐÌÔ*eƒ®4¯dd¤dd ¤;4A°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  R¢ ÐThis€form€may€be€used€in€cases€where€the€Court€agrees€that€an€867€Trust€should€be€created€and€where€theÏCourt€sees€no€need€for€a€guardianship€of€the€estate€(see€notes€to€Appendix€K€and€Appendix€L).Ð ˆØ ÐÌà@%ìàò òNO.€_______ˆÐ \ ¬ ÐÌGUARDIANSHIP€OFà@¿¿*ìàððˆà0  àà0p(#(#àIN€THE€PROBATE€COURTÐü Lp(#p(# Ðà@¿¿*ìàððˆÌ_________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà0 È(#È(#àà0x (# (#àOFМ ì x(#x(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#à______________€COUNTY,€TEXASÐ<Œ p(#p(# ÐÌà@ú ú ìàòòORDER€CREATING€GUARDIANSHIP€MANAGEMENT€TRUSTó óóóˆÐ Þ.  ÐÌà  àOn€this€day€the€Court€considered€the€Application€for€Guardianship€And/Or€Creation€of€GuardianshipÏManagement€Trust€filed€by€__________________€(ð ðApplicantðð)€and€the€Application€for€Creation€ofÏGuardianship€Management€Trust€filed€by€___________________€(ð ðAttorney€Ad€Litemðð),€attorney€ad€litem,Ïregarding€_______________________€(ð ðthe€Wardðð),€òò[a€minor][an€incapacitated€person]óó.€òò[The€Ward€attendedÐ öF Ðthe€hearing€on€the€above€applications.][The€Court€finds€that€the€Wardððs€attendance€at€the€hearing€on€the€aboveÏapplications€is€not€necessary.]óó€After€considering€the€above€applications,€the€evidence€presented,€and€theÐ šê Ðarguments€of€counsel,€the€Court€finds€by€clear€and€convincing€evidence€that€the€Ward€is€an€incapacitated€person;Ïthat€it€is€in€the€best€interest€of€the€Ward€for€the€court€to€create€a€guardianship€management€trust€for€the€WardÏpursuant€to€Tex.€Prob.€Code€Ann.€ðð867;€that€the€rights€of€the€Ward€or€the€Wardððs€property€will€be€protected€byÏthe€creation€of€a€guardianship€management€trust;€and€that,€if€a€guardianship€management€trust€is€created€for€theÏWard,€no€guardianship€of€the€estate€and/or€person€of€the€Ward€is€necessary.€€The€Court€further€finds€by€aÏpreponderance€of€the€evidence€that€the€Court€has€venue€of€this€matter€because€the€Ward€resides€in€this€county;Ð †Ö Ðòò[that€the€Ward€is€a€minor][that€the€Ward€is€totally€without€capacity€as€provided€by€the€Texas€Probate€Code€toÐ X¨ Ðcare€for€himself€or€herself€and€to€manage€the€Wardððs€property][that€the€Ward€lacks€the€capacity€to€do€some,Ïbut€not€all,€of€the€tasks€necessary€to€care€for€himself€or€herself€or€to€manage€the€Wardððs€property];óó€that€theÐ üL ÐWardððs€incapacity€is€evidenced€by€recurring€acts€or€occurrences€within€the€preceding€six„month€period€and€notÏby€isolated€instances€of€negligence€or€bad€judgment;€that€creation€of€a€guardianship€management€trust€pursuantÏto€Tex.€Prob.€Code€Ann.€ðð867€containing€the€terms€and€provisions€of€the€trust€instrument€attached€hereto€asÏExhibit€"A"€and€incorporated€herein€would€be€in€the€best€interests€of€the€Proposed€Ward;€òò[that€it€would€be€inÐ D ”! Ðthe€best€interests€of€the€Ward€for€the€trust€to€be€a€supplemental€needs€trust€as€specified€under€42€U.S.C.€SectionÏ1396p(d)(4)(A);€that€the€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€hereinÏare€necessary€and€appropriate€for€the€Ward€to€be€eligible€to€receive€public€benefits€or€assistance€under€a€stateÏor€federal€program€that€is€not€otherwise€available€to€the€Ward;]óó€that€____________________________Ð Œ#Ü% Ð("Trustee")€is€a€trust€company€or€a€state€or€national€bank€having€trust€powers€in€Texas€and€is€willing€to€serveÏas€trustee€of€the€guardianship€management€trust€for€the€Wardððs€benefit;€that€the€Court€should€direct€that,€uponÏcreation€of€the€guardianship€management€trust,€each€person€holding€property€of€the€Ward€òò[including,€but€notÐ &R!( Ðlimited€to,€____________________________€(specifically€identify€third€parties€holding€the€Wardððs€funds)]óóÐ Ô&$") Ðshall€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estate€of€the€trust;€and€that€upon€entryÏof€the€Courtððs€order€creating€the€guardianship€management€trust,€Attorney€Ad€Litem,€should€be€paid€the€amountÏstated€below€from€the€trust€as€a€reasonable€fee€for€serving€in€such€capacity€and€should€be€discharged.ÌÌà  àIT€IS,€THEREFORE,€ORDERED€that:ÌÌà  à1.à ` àThe€Ward€is€an€incapacitated€person;Ð ’,â'0 ÐÐ d-´(1 Ðà  à2.à ` àA€guardianship€management€trust€for€the€benefit€of€the€Ward€is€established€pursuant€to€Tex.Ð ° ÐProb.€Code€Ann.€ðð867€with€the€terms€and€provisions€set€forth€on€Exhibit€ð ðAðð€attached€hereto€and€incorporatedÏherein;ÌÌà  à3.à ` àNo€guardianship€of€the€estate€and/or€person€of€the€Ward€is€necessary;Ð øH ÐÌà  à4.à ` àòò[The€Ward€is€a€minor][The€Ward€is€totally€without€capacity€as€provided€by€the€Texas€ProbateÐ œ ì ÐCode€to€care€for€himself€or€herself€and€to€manage€the€Wardððs€property][The€Ward€lacks€the€capacity€to€do€theÏfollowing€actions:€______________________________________________];ÌÌà  à5.à ` à[It€is€in€the€best€interests€of€the€Ward€for€the€trust€to€be€a€supplemental€needs€trust€as€specifiedÐ ä 4  Ðunder€42€U.S.C.€Section€1396p(d)(4)(A),€and€the€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"Ïand€incorporated€herein€are€necessary€and€appropriate€for€the€Ward€to€be€eligible€to€receive€public€benefitsÏor€assistance€under€a€state€or€federal€program€that€is€not€otherwise€available€to€the€Ward;]óóÐ Zª  ÐÌà  à6.à ` à€____________________________€("Trustee"),€a€trust€company€or€a€state€or€national€bankÐ þN  Ðhaving€trust€powers€in€Texas,€is€appointed€as€trustee€of€the€guardianship€management€trust€and€is€ordered€toÏadminister€such€trust€in€accordance€with€applicable€law€and€in€accordance€with€the€terms€and€provisions€of€theÏtrust€instrument€attached€hereto€as€Exhibit€ð ðA;ððÌÌà  à7.à ` àUpon€creation€of€the€guardianship€management€trust,€each€person€holding€property€of€the€WardÐ h Ðòò[including,€but€not€limited€to,€____________________________€(specifically€identify€third€parties€holding€theÐ ê: ÐWardððs€funds)]óó€shall€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estate€of€the€trust;Ð ¼  ÐandÌÌà  à8.à ` àAttorney€Ad€Litem€is€awarded€a€fee€in€the€amount€of€$_________________€from€the€trust€asÐ 2‚ Ða€reasonable€fee€for€serving€in€such€capacity€and€is€hereby€discharged.ÌÌà  àSIGNED€this€____€day€of€______________,€_____.ÌÌÌ_________________________________________ÌJudge€PresidingÐ  ð@  Ðà@((ìàò òÔ  ÔAPPENDIX€N€ð"ð€Application€to€Create€867€Trust€From€Existing€GuardianshipÔ ÇÔó óÔ €á ԈР° ÐÌÔ*eƒ°4±dd¤dd ¤®4¯°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  R¢ ÐThis€form€may€be€used€by€the€guardian€or€the€attorney€ad€litem€to€apply€for€creation€of€an€867€Trust€where€aÏguardianship€of€the€estate€already€exists.Ð ˆØ ÐÌà@%ìàò òNO.€_______ˆÐ \ ¬ ÐÌGUARDIANSHIP€OFà@¿¿*ìàððˆà0  àà0p(#(#àIN€THE€PROBATE€COURTÐü Lp(#p(# Ðà@¿¿*ìàððˆÌ_________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà0 È(#È(#àà0x (# (#àOFМ ì x(#x(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#à______________€COUNTY,€TEXASÐ<Œ p(#p(# ÐÌà@kkìàòòAPPLICATION€FOR€CREATION€OF€GUARDIANSHIP€MANAGEMENT€TRUSTóóó óˆÐ Þ.  ÐÌà  à________________________€(ð ðApplicantðð),€òò[guardian€of€the€estate€of][attorney€ad€litem€for]óóÐ €Ð  Ð_____________________€(the€ð ðWardðð),€òò[a€minor][an€incapacitated€person],óó€files€this€application€for€theÐ R¢  Ðcreation€of€a€guardianship€management€trust€for€the€benefit€of€the€Ward€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867.€ÏIn€support€of€this€application,€Applicant€would€show€the€Court€as€follows:ÌÌà  à1.à ` àThe€Ward€is€òò[a€minor][an€incapacitated€person].óó€€A€guardianship€of€the€estate€of€the€WardÐ šê Ðexists€in€this€Court.ÌÌà  à2.à ` àCreation€of€a€guardianship€management€trust€pursuant€to€Tex.€Prob.€Code€Ann.€Ô% €~ Ôðð867€containingÐ ` Ðthe€terms€and€provisions€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€wouldÏbe€in€the€best€interests€of€Plaintiff.€€òò[If€desired,€state€the€reasons€for€creation€of€the€867€Trust.]óóÐ ´ ÐÌÔ*eƒ…4¡dd¤dd ¤°4±°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  X¨ Ðà@ä ä ‚àò òOPTIONAL€SUPPLEMENTAL€NEEDS€TRUST€PROVISIONS:ó óˆÐ ¼  ÐÌØ€JØà l à3.à Ä àIt€would€be€in€the€best€interests€of€the€Ward€for€the€trust€to€be€a€supplemental€needs€trust€asÐ ^® Ðspecified€under€42€U.S.C.€Section€1396p(d)(4)(A).ÌÌØ€JØà l à4.à Ä àThe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€areÐ Ô$! Ðnecessary€and€appropriate€for€the€Ward€to€be€eligible€to€receive€public€benefits€or€assistance€under€a€state€orÏfederal€program€that€is€not€otherwise€available€to€the€Ward.Ð x!È# ÐÌà  à3.òò[5.]óóà ` à__________________€("Trustee")€is€a€trust€company€or€a€state€or€national€bank€having€trustÐ L#œ$ Ðpowers€in€Texas€and€is€willing€to€serve€as€trustee€of€the€guardianship€management€trust€for€the€Wardððs€benefit.ÌÌà  à4.òò[6.]óóà ` àThe€Court€should€direct€that,€upon€creation€of€the€guardianship€management€trust,€the€guardianÐ Â%!' Ðof€the€estate€of€the€Ward€and€any€other€person€holding€property€of€the€Ward€òò[including,€but€not€limited€to,Ð ”&ä!( Ð____________________________€(specifically€identify€third€parties€holding€the€Wardððs€funds)]óó€shall€deliverÐ f'¶") Ðall€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estate€of€the€trust.ÌÌà  à5.òò[7.]óóà ` àUpon€creation€of€the€guardianship€management€trust€and€upon€the€transfer€of€all€assets€in€theÐ Ü),%, Ðpossession€or€control€of€the€guardian€of€the€estate€of€the€Ward€to€Trustee,€the€Court€should€discharge€theÏguardian€of€the€wardððs€estate€pursuant€to€Tex.€Prob.€Code€Ann.€ðð868A.à È àÐ €+Ð&. ÐÌØ€JØà  à6.òò[8.]óóà ` àòò[If€desired€or€appropriate:]óóUpon€entry€of€the€Courtððs€order€creating€the€guardianshipÐ $-t(0 Ðmanagement€trust,€__________________,€attorney€ad€litem€for€the€Ward,€should€be€paid€a€reasonable€fee€fromÐ ö-F)1 Ðthe€guardianship€estate€or€the€trust€and€should€be€discharged.ÌÌà@ŽŽ'ìàPRAYERˆÌÌà  àApplicant€prays€that€the€Court€will€make€the€findings€and€determinations€described€above,€that€the€CourtÏwill€create€a€guardianship€management€trust€for€the€benefit€of€the€Ward€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867Ïwith€those€terms€and€provisions€set€forth€in€Exhibit€"A"€attached€hereto€and€incorporated€herein;€that€the€CourtÏwill€name€Trustee€as€trustee€of€such€trust;€òò[that€the€trust€shall€be€a€supplemental€needs€trust€as€specified€underÐ n ¾ Ð42€U.S.C.€Section€1396p(d)(4)(A);]óó€that€the€Court€will€order€the€guardian€of€the€estate€of€the€Ward€and€any€otherÐ @  Ðperson€holding€property€of€the€Ward€to€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trustÏestate€of€the€trust;€that€upon€creation€of€the€guardianship€management€trust€and€upon€the€transfer€of€all€assetsÏin€the€possession€or€control€of€the€guardian€of€the€estate€of€the€Ward€to€Trustee,€the€€guardian€of€the€WardððsÏestate€shall€be€discharged€pursuant€to€Tex.€Prob.€Code€Ann.€ðð868A;€òò[that€the€Court€will€awardÐ ˆØ  Ð_______________,€attorney€ad€litem,€a€reasonable€fee,€to€be€paid€by€the€guardian€of€the€estate€of€the€Ward€orÏby€Trustee€upon€funding€of€the€trust€(if€not€sooner€paid)];€that€the€Court€will€discharge€said€attorney€ad€litem;óóÐ ,|  Ðand€that€the€Court€will€grant€such€other€and€further€relief€to€which€Plaintiff€may€be€entitled.ÌÌRespectfully€submitted,ÌÌATTORNEY€FOR€APPLICANTÐ  F– Ðà@  ìàò òÔ  ÔAPPENDIX€O€ð"ð€Order€Creating€867€Trust€From€Existing€GuardianshipÔ ^+ÔÔ €â ԈР° Ðó óÌÌÌà@%ìàò òNO.€_______ˆÐ öF ÐÌGUARDIANSHIP€OFà@¿¿*ìàððˆà0  àà0p(#(#àIN€THE€PROBATE€COURTЖ æp(#p(# Ðà@¿¿*ìàððˆÌ_________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà0 È(#È(#àà0x (# (#àOFÐ6 †x(#x(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#à______________€COUNTY,€TEXASÐÖ & p(#p(# ÐÌà@ú ú ìàòòORDER€CREATING€GUARDIANSHIP€MANAGEMENT€TRUSTó óóóˆÐ xÈ  ÐÌà  àOn€this€day€the€Court€considered€the€Application€for€Creation€of€Guardianship€Management€Trust€filedÏby€___________________,€òò[attorney€ad€litem€for€___________________€(ð ðthe€Wardðð)][guardian€of€the€estateÐ ì<  Ðof€______________________€(ð ðthe€Wardðð)],óó€òò[a€minor][an€incapacitated€person]óó.€€After€considering€the€aboveÐ ¾  Ðapplications,€the€evidence€presented,€and€the€arguments€of€counsel,€the€Court€finds€that€the€Ward€is€anÏincapacitated€person;€that€it€is€in€the€best€interest€of€the€Ward€for€the€Court€to€create€a€guardianship€managementÏtrust€for€the€Ward€pursuant€to€Tex.€Prob.€Code€Ann.€ðð867€containing€the€terms€and€provisions€of€the€trustÏinstrument€attached€hereto€as€Exhibit€ð ðAðð€and€incorporated€herein;€òò[that€it€would€be€in€the€best€interests€of€theÐ V ÐWard€for€the€trust€to€be€a€supplemental€needs€trust€as€specified€under€42€U.S.C.€Section€1396p(d)(4)(A);€thatÏthe€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"€and€incorporated€herein€are€necessary€andÏappropriate€for€the€Ward€to€be€eligible€to€receive€public€benefits€or€assistance€under€a€state€or€federal€programÏthat€is€not€otherwise€available€to€the€Ward;]óó€that€____________________________€("Trustee")€is€a€trustÐ Nž Ðcompany€or€a€state€or€national€bank€having€trust€powers€in€Texas€and€is€willing€to€serve€as€trustee€of€theÏguardianship€management€trust€for€the€Wardððs€benefit;€that€the€Court€should€direct€that,€upon€creation€of€theÏguardianship€management€trust,€the€guardian€of€the€estate€of€the€Ward€and€each€person€holding€property€of€theÏWard€òò[including,€but€not€limited€to,€____________________________€(specifically€identify€third€partiesÐ –æ Ðholding€the€Wardððs€funds)]óó€shall€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estateÐ h¸ Ðof€the€trust;€that,€upon€creation€of€the€guardianship€management€trust€and€the€transfer€of€all€assets€in€theÏpossession€and€control€of€the€guardian€of€the€estate€of€the€Ward€to€the€Trustee,€no€guardianship€of€the€estate€ofÏthe€Ward€is€necessary€and€_____________€should€be€discharged€as€guardian€of€the€estate;€and€that€upon€entryÏof€the€Courtððs€order€creating€the€guardianship€management€trust,€_________________,€attorney€ad€litem,€shouldÏbe€paid€the€amount€stated€below€from€the€trust€as€a€reasonable€fee€for€serving€in€such€capacity€and€should€beÏdischarged.ÌÌà  àIT€IS,€THEREFORE,€ORDERED€that:ÌÌà  à1.à ` àA€guardianship€management€trust€for€the€benefit€of€the€Ward€is€established€pursuant€to€Tex.Ð œ$ì' ÐProb.€Code€Ann.€ðð867€with€the€terms€and€provisions€set€forth€on€Exhibit€ð ðAðð€attached€hereto€and€incorporatedÏherein;ÌÌà  àòò2.à ` à[It€is€in€the€best€interests€of€the€Ward€for€the€trust€to€be€a€supplemental€needs€trust€as€specifiedÐ ä'4#+ Ðunder€42€U.S.C.€Section€1396p(d)(4)(A),€and€the€terms€of€the€trust€instrument€attached€hereto€as€Exhibit€"A"Ïand€incorporated€herein€are€necessary€and€appropriate€for€the€Ward€to€be€eligible€to€receive€public€benefitsÏor€assistance€under€a€state€or€federal€program€that€is€not€otherwise€available€to€the€Ward;]óóÐ Z*ª%. ÐÌà  à3.à ` à€____________________________€("Trustee"),€a€trust€company€or€a€state€or€national€bankÐ þ+N'0 Ðhaving€trust€powers€in€Texas,€is€appointed€as€trustee€of€the€guardianship€management€trust€and€is€ordered€toÏadminister€such€trust€in€accordance€with€applicable€law€and€in€accordance€with€the€terms€and€provisions€of€theÐ ¢-ò(2 Ðtrust€instrument€attached€hereto€as€Exhibit€ð ðA;ððÌÌà  à4.à ` àThe€guardian€of€the€estate€of€the€Ward€and€each€person€holding€property€of€the€WardÐ T¤ Ðòò[including,€but€not€limited€to,€____________________________€(specifically€identify€third€parties€holding€theÐ &v ÐWardððs€funds)]óó€shall€deliver€all€of€such€assets€to€Trustee,€to€be€held€by€Trustee€as€the€trust€estate€of€the€trust;Ð øH ÐÌà  à5.à ` àUpon€creation€of€the€guardianship€management€trust€and€the€transfer€of€all€assets€in€theÐ œ ì Ðpossession€and€control€of€the€guardian€of€the€estate€of€the€Ward€to€the€Trustee,€no€guardianship€of€the€estate€ofÏthe€Ward€is€necessary€and€_____________€should€be€discharged€as€guardian€of€the€estateòò[;€andÐ @  ÐÌà  à6.à ` à______________________,€attorney€ad€litem,€is€awarded€a€fee€in€the€amount€ofÐ ä 4  Ð$_________________€from€the€trust€as€a€reasonable€fee€for€serving€in€such€capacity€and€is€hereby€discharged.]óóÐ ¶   ÐÌà  àSIGNED€this€____€day€of€______________,€_____.ÌÌÌ_________________________________________ÌJudge€PresidingÐ  ¢ò  Ðà@±±ìàò òÔ  ÔAPPENDIX€P€„„€Form€of€867€TrustÔ ‹AÔó óÔ €ã ԈР° ÐÌÓC€ + ÿÿ$7&CÓà@--%ìàò òNO.€______ˆÐ R¢ ÐÌGUARDIANSHIP€OF€THE€ESTATEà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àIN€THE€PROBATE€COURTÐòBÈ(#È(# Ðà@¿¿*ìàððˆÌOF€________________________,à@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#àà  à€€€€OFÐ’ âÈ(#È(# Ðà@¿¿*ìàððˆÌòò[A€MINOR][AN€INCAPACITATED€PERSON]óóà@¿¿*ìàððˆà0  àà0p(#(#àà0Èp(#p(#à____________€COUNTY,Ð 2 ‚ ÐTEXASó óÐ T È(#È(# ÐÌà@RRìàò òGUARDIANSHIP€MANAGEMENT€TRUST€FOR€_______________________ó óˆÐ ¦ ö  ÐÌà  àThis€declaration€of€trust€creates€a€management€trust€(the€"Trust")€for€the€benefit€ofÏ____________________€(the€"Beneficiary")€with€__________________€(the€"Trustee")€as€trustee.ÌÌà  àÔ2ÿÿ ÔÚ  Ú13Ú  Ú.Ô3  Ôà ` àò òAuthority€for€Creation.ó ó€€This€Trust€is€created€by€the€order€of€the€Probate€Court€ofÐ ¾  Ð_____________€County,€Texas€(the€"Court")€in€Cause€No.€_________,€Guardianship€of€the€Estate€of€theÏBeneficiary,€pursuant€to€Sections€867€„„€873€of€the€Texas€Probate€Code.ÌÌà  àÔ2ÿÿ ÔÚ  Ú14Ú  Ú.Ô3  Ôà ` àò òTransfer€to€Trust.ó óà h àThe€initial€trust€estate€of€the€Trust€shall€be€the€property€described€onÐ X ÐSchedule€"A"€attached€hereto.€€Additional€property€acceptable€to€the€Trustee€may€be€transferred€to€the€TrustÏfrom€time€to€time€and€added€to€the€trust€estate.ÌÌà  àÔ2ÿÿÔÚ  Ú15Ú  Ú.Ô3  Ôà ` àò òDistributions€During€Term€of€Trust.ó ó€€The€Beneficiary€shall€be€the€sole€beneficiary€of€theÐ R¢ ÐTrust.€€Prior€to€termination€of€the€Trust,€the€Trustee€may€disburse€that€amount€of€the€Trust's€principal€or€incomeÏas€the€Trustee€determines€is€necessary€to€expend€for€the€health,€education,€support,€or€maintenance€of€theÏBeneficiary.€€In€addition,€the€Trustee€may€make€a€distribution,€payment,€use,€or€application€of€trust€funds€for€theÏhealth,€education,€support,€or€maintenance€of€the€Beneficiary€or€of€another€person€whom€the€Beneficiary€isÏlegally€obligated€to€support,€as€necessary€and€without€the€intervention€of€a€guardian€or€other€representative€ofÏthe€Beneficiary,€to:€(A)€the€Beneficiaryððs€guardian;€(B)€a€person€who€has€physical€custody€of€the€BeneficiaryÏor€another€person€whom€the€Beneficiary€is€legally€obligated€to€support;€or€(C)€a€person€providing€a€good€orÏservice€to€the€Beneficiary€or€another€person€whom€the€Beneficiary€is€legally€obligated€to€support.€€The€incomeÏof€the€Trust€that€the€Trustee€does€not€disburse€under€this€section€must€be€added€to€the€principal€of€the€Trust.ÌÌà  àÔ2ÿÿÔÚ  Ú16Ú  Ú.Ô3  Ôà ` àò òTermination€of€Trust.ó ó€€The€Trust€will€terminate€on€the€earlier€of:€€(a)€the€death€of€theÐ Z!ª# ÐBeneficiary;€or€(b)€òò[on€the€Beneficiaryððs€eighteenth€(18th)€birthday,€unless€the€Court€orders€that€the€trust€shallÐ ."~$ Ðterminate€on€a€date€later€than€the€Beneficiaryððs€eighteenth€(18th)€birthday,€which€date€may€not€be€later€thanÏthe€Beneficiaryððs€twenty„fifth€(25th)€birthday][on€the€date€the€Court€determines€that€continuing€the€trust€is€noÏlonger€in€the€Beneficiaryððs€best€interests]óó.€€The€Trust€also€may€be€terminated€in€whole€or€in€part€at€any€time€byÐ ¤$ô' Ðorder€of€the€Court.ÌÌà  àÔ2ÿÿÔÚ  Ú17Ú  Ú.Ô3  Ôà ` àò òDistribution€Upon€Termination€of€Trust.€€ó óUpon€termination€of€the€Trust,€the€trustee€shallÐ 'j"* Ðprepare€and€file€the€final€account€required€by€Tex.€Prob.€Code€Ann.€ðð€873€and,€upon€approval€of€the€Court€andÏunless€otherwise€provided€by€the€Court,€shall€distribute€the€principal€and€any€undistributed€income€of€the€TrustÏto€the€Beneficiary,€outright€and€free€of€trust,€or,€if€the€Beneficiary€is€then€deceased,€to€the€representative€of€theÏdeceased€Beneficiaryððs€estate.ÌÌÔ*eƒª4«dd¤dd ¤…4¡°(#°(#eÔÔ,Âdd ÔÔ+  ÔÐ  ,X'0 €€Ðà@©©‘àò òIf€This€is€a€(d)(4)(A)€trust,€use€the€following€alternative€paragraphs€3.,€4.€and€5.€insteadó óˆÐ l,¼'1 ÐÐ <-Œ(2 Ðà l à3.à Ä àò òDistributions€During€Term€of€Trust.ó ó€€The€following€provisions€shall€govern€distributionsÐ d Ðfrom€the€Trust€during€the€term€of€this€Trust:ÌÌà l àà Ä àA.à  àò òPurpose€and€Intent.ó ó€€This€Trust€is€created€pursuant€to€42€U.€S.€C.€ðð1396p(d)(4)(A).€Ð ŒÜ ÐIt€is€intended€to€be€construed€and€administered€as€a€ð ðsupplemental€needsðð€trust€under€42€U.€S.€C.Ïðð1396p(d)(4)(A).€€Without€limiting€the€foregoing,€neither€the€corpus€of€the€Trust€nor€distributions€from€theÏTrust€shall€ever€cause€the€Beneficiary€to€be€disqualified€to€receive€those€public€benefits€or€assistance€under€aÏstate€or€federal€program€to€which€the€Beneficiary€then€may€be€entitled€but€for€the€existence€of€this€Trust€or€butÏfor€the€distributions€from€this€Trust.ÌÌà l àà Ä àB.à  àò òDistribution€Standard.ó ó€€During€the€term€of€this€Trust,€the€Trustee€shall€apply€for€theÐ L œ  Ðbenefit€of€the€Beneficiary€those€amounts€of€the€principal€and/or€income€of€the€Trust€for€the€satisfaction€of€theÏBeneficiaryððs€supplemental€needs€(defined€below),€as€the€Trustee,€in€the€Trustee's€sole€and€absolute€discretion,Ïmay€from€time€to€time€deem€appropriate,€subject€to€the€strict€limitations€set€out€in€this€instrument.€€€AnyÏincome€of€the€trust€not€distributed€shall€be€added€to€the€principal.€€The€Trustee€may€apply€such€trust€funds€forÏthe€benefit€of€the€Beneficiary,€as€necessary€and€without€the€intervention€of€a€guardian€or€other€representativeÏof€the€Beneficiary,€to:€(A)€the€Beneficiaryððs€guardian;€(B)€a€person€who€has€physical€custody€of€theÏBeneficiary;€or€(C)€a€person€providing€a€good€or€service€to€the€Beneficiary.€€ÌÌà l àà Ä àC.à  àò òSupplemental€Needs.€€ó óAs€used€in€this€instrument,€"supplemental€needs"€refers€to€theÐ ° Ðrequisites,€as€allowed€for€in€42€U.€S.€C.€ðð1396p(d)(4)(A),€for€maintaining€the€Beneficiaryððs€health,€safety,€andÏwelfare€when€the€Trustee€determines,€in€its€discretion,€that€such€needs€are€not€being€provided€for€by€anyÏpublic€or€private€agency,€including€any€state,€the€United€States,€or€any€insurance€carrier€with€insuranceÏpolicies€covering€the€Beneficiary.€€The€Trustee€is€prohibited€from€expending€any€of€the€trust€principal€orÏincome€for€any€property,€services,€benefits,€or€medical€care€which€are€being€received€by,€or€which€areÏotherwise€available€to,€the€Beneficiary€from€any€governmental€source€or€from€any€insurance€carrier€required€toÏcover€the€Beneficiary.€€Further,€the€Trustee€is€prohibited€from€expending€any€of€the€trust€principal€or€incomeÏfor€any€such€property,€services,€benefits,€or€medical€care€if€that€restriction€is€necessary€in€order€to€qualify€theÏBeneficiary€for€such€governmental€or€insurance€carrier€benefits€because€an€application€for€such€property,Ïservices,€benefits,€or€medical€care€has€been€filed€with€an€applicable€governmental€agency€or€insurance€carrierÏon€the€Beneficiary's€behalf.€€The€Trustee€may€pay€any€deductible€amounts€for€the€Beneficiary€on€any€insuranceÏpolicies€covering€the€Beneficiary€so€long€as€that€payment€does€not€disqualify€the€Beneficiary€from€receipt€ofÏbenefits.€€The€Trustee€shall€cooperate€with€the€Beneficiaryððs€conservator,€guardian,€or€legal€representative€toÏseek€support€and€maintenance€for€the€Beneficiary€from€all€available€resources,€including€but€not€limited€to,€theÏSupplemental€Social€Security€Income€Program€(SSI),€Supplemental€Income€Program€(SIP)€of€Texas,€the€OldÏAge€Survivor€and€Disability€Insurance€Program€(OASDI),€the€Medicaid€Program,€and€any€additional€similarÏor€successor€programs,€and€from€any€private€sources.€€To€the€extent€required€by€42€U.€S.€C.€ðð1396p(d)(4)(A)Ïand€other€applicable€laws€and€regulations€regarding€trusts€of€this€type,€the€Trustee€òòòòmay€supplement,€but€shallÐ v#Æ& Ðnot€supplantóó,óó€services,€benefits,€and€medical€care€received€or€requested€by€or€on€behalf€of€the€Beneficiary€thatÐ H$˜' Ðare€available€through€any€governmental€or€private€resource.ÌÌà l àà Ä àD.à  àò òPayment€of€Income€Taxes.ó ó€€The€Trustee€shall€pay€any€income€tax€liability€of€theÐ ¾&"* ÐBeneficiary€which€results€from€income€received€by€the€Trust€but€reported€on€the€income€tax€return€of€theÏBeneficiary.€€The€funds€used€to€pay€this€income€tax€liability€shall€be€paid€directly€to€the€appropriate€taxingÏauthority€and€shall€not€be€available€to€the€Beneficiary.€€The€Beneficiary€shall€not€have€any€right€to€or€interestÏin€any€of€these€funds€paid€by€the€Trustee.€€Further,€these€funds€are€not€a€resource€of€the€Beneficiary€and€shallÏnot€be€treated€as€a€distribution€of€cash€for€purposes€of€Medicaid€qualification.ÌÌà l à4.à Ä àò òTermination€of€Trust.ó ó€€The€Trust€will€terminate€on€the€death€of€the€Beneficiary.€€The€TrustÐ ~,Î'1 Ðalso€may€be€terminated€in€whole€or€in€part€at€any€time€by€order€of€the€Court.Ð R-¢(2 Їà l à5.à Ä àò òDistribution€Upon€Termination€of€Trust.€€ó óUpon€termination€of€the€Trust,€the€trustee€shallÐ d Ðdistribute€the€principal€and€any€undistributed€income€of€the€Trust€as€follows:Ìà l àÌà l àà Ä àA.à  àFirst,€the€Trustee€shall€pay€all€amounts€required€to€be€reimbursed€pursuant€to€42€U.Ð ŒÜ ÐS.€C.€ðð1396p(d)(4)(A).€€The€Trustee€shall€reimburse€those€states€where€the€Beneficiary€has€received€MedicalÏAssistance€payments€from€the€state,€based€upon€the€state's€proportionate€share€of€the€total€amount€of€MedicaidÏbenefits€paid€by€all€of€the€states€on€the€Beneficiaryððs€behalf,€the€smallest€amount€(if€any)€as€applicable€lawÏthen€requires€the€Trust€to€pay.€€The€Trustee's€duty€to€reimburse€the€state€upon€termination€shall€apply€to€theÏextent€there€are€remaining€assets€in€this€trust€and€shall€apply€irrespective€of€any€other€provision€of€thisÏinstrument.€€€The€Trustee€shall€reimburse€the€state€only€for€those€benefits€provided€to€the€Beneficiary€whichÏare€subject€to€such€reimbursement€claim.ÌÌà l àà Ä àB.à  àAfter€the€satisfaction€of€these€obligations,€the€Trustee€shall€distribute€the€remainingÐ î>  Ðproperty,€if€any,€to€the€Beneficiary,€outright€and€free€of€trust,€or,€if€the€Beneficiary€is€then€deceased,€to€theÏrepresentative€of€the€deceased€Beneficiaryððs€estate.Ð’â   ÐÌà  àÔ2ÿÿÔÚ  Ú18Ú  Ú.Ô3  Ôà ` àò òAnnual€Accountings.ó ó€€The€Trustee€shall€prepare€and€file€with€the€court€an€annual€accountingÐ f¶  Ðof€transactions€in€the€Trust€in€the€same€manner€and€form€that€is€required€of€a€guardian€of€the€estate€under€theÏTexas€Probate€Code.€€The€Trustee€shall€provide€a€copy€of€the€annual€account€to€the€Guardian€of€the€Beneficiary'sÏEstate€and€Person.€€The€annual€account€is€subject€to€review€and€approval€by€the€Court€in€the€same€manner€thatÏis€required€of€an€annual€account€prepared€by€a€guardian€of€the€estate€under€the€Texas€Probate€Code.ÌÌà  àÔ2ÿÿÔÚ  Ú19Ú  Ú.Ô3  Ôà ` àò òCompensation€of€the€Trustee.ó ó€€The€Trustee,€on€annual€application€to€the€Court€and€subjectÐ T¤ Ðto€the€Court's€approval,€is€entitled€to€receive€reasonable€compensation€for€services€that€the€Trustee€provided€toÏthe€Beneficiary€as€the€Beneficiary's€Trustee€that€is€(A)€to€be€paid€from€the€Trust's€income,€principal,€or€both€andÏ(B)€determined€in€the€same€manner€as€compensation€of€a€guardian€of€the€estate€under€Section€665€of€the€TexasÏProbate€Code;€provided,€however,€that€the€Trustee€shall€not€be€entitled€to€compensation€based€on€distributionsÏto€the€Guardian€of€the€Estate€of€the€Beneficiary€for€purposes€of€making€gifts€pursuant€to€Section€865€of€the€TexasÏProbate€Code.€€The€Trustee€may€be€reimbursed€from€the€trust€estate€for€expenses€it€reasonably€incurs€with€theÏapproval€of€the€Court.ÌÌà  àÔ2ÿÿÔÚ  Ú20Ú  Ú.Ô3  Ôà ` àò òPowers€of€Trustee.ó ó€€The€Trustee€shall€have€all€of€the€powers€of€trustees€under€the€Texas€TrustÐ ¸ ÐCode.€€The€Trustee€may€invest€the€trust€estate€in€investments€permitted€under€the€Texas€Trust€Code€withoutÏfurther€order€of€the€Court€and€is€not€required€to€invest€the€trust€estate€in€investments€permitted€by€Section€855Ïof€the€Texas€Probate€Code.€€The€terms€and€provisions€of€the€Texas€Trust€Code€shall€apply€to€this€Trust,€to€theÏextent€they€are€not€in€conflict€with€Tex.€Prob.€Code€Ann.€ðððð€867„873€or€with€the€terms€of€this€instrument.ÌÌà  àÔ2ÿÿÔÚ  Ú21Ú  Ú.Ô3  Ôà ` àò òNo€Bond€Required.ó ó€€The€Trustee€shall€serve€without€giving€a€bond.€€Neither€the€Guardian€ofÐ ¦#ö% Ðthe€Estate€of€the€Beneficiary€nor€the€surety€on€the€Guardian's€bond€(if€any)€shall€be€liable€for€an€act€or€omissionÏof€the€Trustee.ÌÌà  àÔ2ÿÿÔÚ  Ú22Ú  Ú.Ô3  Ôà ` àò òSuccessor€Trustees.ó ó€€In€the€event€of€the€corporate€reorganization,€merger€or€acquisition€of€theÐ ð&@") ÐTrustee,€the€resulting€successor€organization€shall€automatically€become€the€successor€trustee.€€The€Trustee€mayÏresign€with€the€approval€of€the€Court€and€may€be€removed€by€order€of€the€Court.€€Upon€the€resignation€orÏremoval€of€the€Trustee,€the€Court€shall€appoint€a€successor€trustee.€€Each€successor€trustee€shall€have€all€of€theÏrights,€powers€and€duties€of€the€Trustee.ÌÌà  àÔ2ÿÿÔÚ  Ú23Ú  Ú.Ô3  Ôà ` àò òSpendthrift€Trust.ó ó€€To€the€extent€permitted€by€law,€the€interest€of€the€Beneficiary€shall€be€heldÐ Þ+.'/ Ðsubject€to€a€spendthrift€trust€as€provided€in€Section€112.035€of€the€Texas€Property€Code.ÌÐ „-Ô(1 Ðà  àÔ2ÿÿÔÚ  Ú24Ú  Ú.Ô3  Ôà ` àò òAmendment,€Modification€or€Revocation.ó ó€€The€Court€may€amend,€modify,€or€revoke€the€TrustÐ ° Ðat€any€time€before€the€date€of€the€Trust's€termination.€€Neither€the€Beneficiary€nor€the€guardian€of€theÏBeneficiary's€estate€may€revoke€the€Trust.ÌÌà  àÔ2ÿÿÔÚ  Ú25Ú  Ú.Ô3  Ôà ` àò òEffective€Date.ó ó€€€This€Trust€shall€be€effective€upon€the€last€to€occur€of€(A)€the€entry€of€an€orderÐ úJ Ðcreating€the€Trust€by€the€Court,€(B)€the€execution€of€this€Declaration€of€Trust€by€the€Trustee€indicating€itsÏacceptance€of€the€Trust;€and€(C)€the€receipt€by€the€Trustee€of€the€initial€trust€estate.ÌÌTRUSTEE'S€ACCEPTANCE:ÌBy:_______________________ÌName:_____________________ÌTitle:______________________Ð  º  Ðà@´ ´ ìàò òÔ  ÔAPPENDIX€Q€ð"ð€Supplemental€Needs€Trust€Created€by€Third€PartyÔ Ï}Ôó óÔ €ä ԈР° ÐÌÔ*eƒ4‚ddÂdd ª4«°(#°(#eÔÔ,¤dd ÔÔ+  ÔÐ  R¢ ÐThis€is€not€a€court„created€trust,€nor€does€it€meet€the€requirements€of€42€U.€S.€C.€ðð1396p(d)(4)(A).€€Rather,Ïthis€is€a€form€of€trust€which€may€be€used€by€a€parent€or€other€relative€as€a€means€of€transferring€property€fromÏthe€parent€or€relative€for€the€benefit€of€a€person€receiving€governmental€assistance€without€disqualifying€thatÏperson€from€receiving€such€assistance.€€The€most€significant€distinction€between€this€trust€and€a€(d)(4)(A)Ïtrust€is€that€this€trust€contains€no€provision€for€reimbursing€the€state€upon€the€death€of€the€beneficiary,€sinceÏreimbursement€is€not€required€for€a€trust€holding€a€third€partyððs€funds€(rather€than€the€beneficiaryððs€funds).Ð Ð  Ðò òÌà@‰ ‰ ìàSUPPLEMENTAL€NEEDS€TRUST€FOR€__________________ó óˆÐ ¢ ò  ÐÌà  àThis€trust€agreement€is€made€by€and€between€____________________€(ð ðSettlorðð)€as€settlor€andÏ__________________€(ð ðTrusteeðð)€as€trustee€in€order€to€create€a€trust€(the€ð ðTrustðð)€for€the€primary€benefit€ofÏ_____________€(ð ðBeneficiaryðð).ÌÌà  àÔ2ÿÿÔÚ  Ú26Ú  Ú.Ô3  Ôà ` àò òTransfer€to€Trust.ó óà h àSettlor€transfers€to€Trustee€the€property€described€on€Schedule€"A"Ð ŒÜ  Ðattached€hereto€as€the€initial€trust€estate€of€the€Trust.€€The€Trustee€accepts€such€property.€€Additional€propertyÏacceptable€to€the€Trustee€may€be€transferred€to€the€Trust€from€time€to€time€by€anyone€and€added€to€the€trustÏestate.Ìà  àÌà  àòò[2.à ` àò òTrust€Irrevocable.ó ó€€This€trust€is€irrevocable.][2.€€ò òTrust€Revocable.ó ó€€This€trust€may€be€revokedÐ ¨ø Ðor€amended€in€whole€or€in€part€by€Settlor€during€Settlorððs€lifetime.€€After€Settlorððs€death,€this€Trust€shall€becomeÏirrevocable.]óóÐ Lœ ÐÌà  à3.à ` àò òDistributions€During€Term€of€Trust.ó ó€€The€following€provisions€shall€govern€distributionsÐ ð@ Ðfrom€the€Trust€during€the€term€of€this€Trust:ÌÌà  àà ` àA.à ¸ àò òPurpose€and€Intent.ó ó€€This€Trust€is€intended€to€be€construed€and€administered€as€aÐ h¸ Ðð ðsupplemental€needsðð€trust.€€Without€limiting€the€foregoing,€neither€the€corpus€of€the€Trust€nor€distributionsÏfrom€the€Trust€shall€ever€cause€the€Beneficiary€to€be€disqualified€to€receive€those€public€benefits€or€assistanceÏunder€a€state€or€federal€program€to€which€the€Beneficiary€then€may€be€entitled€but€for€the€existence€of€this€TrustÏor€but€for€the€distributions€from€this€Trust.ÌÌà  àà ` àB.à ¸ àò òDistribution€Standard.ó ó€€During€the€term€of€this€Trust,€the€Trustee€shall€apply€for€theÐ V ¦! Ðbenefit€of€the€Beneficiary€those€amounts€of€the€principal€and/or€income€of€the€Trust€for€the€satisfaction€of€theÏBeneficiaryððs€supplemental€needs€(defined€below),€as€the€Trustee,€in€the€Trustee's€sole€and€absolute€discretion,Ïmay€from€time€to€time€deem€appropriate,€subject€to€the€strict€limitations€set€out€in€this€instrument.€€€Any€incomeÏof€the€trust€not€distributed€shall€be€added€to€the€principal.ÌÌà  àà ` àC.à ¸ àò òSupplemental€Needs.€€ó óAs€used€in€this€instrument,€"supplemental€needs"€refers€to€theÐ D%” ' Ðrequisites€for€maintaining€the€Beneficiaryððs€health,€safety,€and€welfare€when€the€Trustee€determines,€in€itsÏdiscretion,€that€such€needs€are€not€being€provided€for€by€any€public€or€private€agency,€including€any€state,€theÏUnited€States,€or€any€insurance€carrier€with€insurance€policies€covering€the€Beneficiary.€à x àThe€Trustee€isÐ ¼' #* Ðprohibited€from€expending€any€of€the€trust€principal€or€income€for€any€property,€services,€benefits,€or€medicalÏcare€which€are€being€received€by,€or€which€are€otherwise€available€to,€the€Beneficiary€from€any€governmentalÏsource€or€from€any€insurance€carrier€required€to€cover€the€Beneficiary.€€Further,€the€Trustee€is€prohibited€fromÏexpending€any€of€the€trust€principal€or€income€for€any€such€property,€services,€benefits,€or€medical€care€if€thatÏrestriction€is€necessary€in€order€to€qualify€the€Beneficiary€for€such€governmental€or€insurance€carrier€benefitsÏbecause€an€application€for€such€property,€services,€benefits,€or€medical€care€has€been€filed€with€an€applicableÏgovernmental€agency€or€insurance€carrier€on€the€Beneficiary's€behalf.€€The€Trustee€may€pay€any€Ô_ÔdeductibleÐ z-Ê(1 Ðamounts€for€the€Beneficiary€on€any€insurance€policies€covering€the€Beneficiary€so€long€as€that€payment€does€notÏdisqualify€the€Beneficiary€from€receipt€of€benefits.€€The€Trustee€shall€cooperate€with€the€BeneficiaryððsÏconservator,€guardian,€or€legal€representative€to€seek€support€and€maintenance€for€the€Beneficiary€from€allÏavailable€resources,€including€but€not€limited€to,€the€Supplemental€Social€Security€Income€Program€(SSI),ÏSupplemental€Income€Program€(SIP)€of€Texas,€the€Old€Age€Survivor€and€Disability€Insurance€ProgramÏ(Ô_ÔOASDIÔ_Ô),€the€Medicaid€Program,€and€any€additional€similar€or€successor€programs,€and€from€any€privateÏsources.€€The€Trustee€òòòòmay€supplement,€but€shall€not€supplantóó,óó€services,€benefits,€and€medical€care€received€orÐ œ ì Ðrequested€by€or€on€behalf€of€the€Beneficiary€that€are€available€through€any€governmental€or€private€resource.Ìà  àà ` àà ¸ àÌà  àà ` àD.à ¸ àò òPayment€of€Income€Taxes.ó ó€€The€Trustee€shall€pay€any€income€tax€liability€of€theÐ  b  ÐBeneficiary€which€results€from€income€received€by€the€Trust€but€reported€on€the€income€tax€return€of€theÏBeneficiary.€€The€funds€used€to€pay€this€income€tax€liability€shall€be€paid€directly€to€the€appropriate€taxingÏauthority€and€shall€not€be€available€to€the€Beneficiary.€€The€Beneficiary€shall€not€have€any€right€to€or€interestÏin€any€of€these€funds€paid€by€the€Trustee.€€Further,€these€funds€are€not€a€resource€of€the€Beneficiary€and€shallÏnot€be€treated€as€a€distribution€of€cash€for€purposes€of€Medicaid€qualification.ÌÌà  à4.à ` àò òFacility€of€Payment.ó ó€€Notwithstanding€anything€to€the€contrary€in€this€instrument,€the€Trustee,Ð Ò"  Ðin€its€sole€discretion,€may€make€any€distribution€required€or€permitted€to€be€made€under€this€instrument€in€anyÏof€the€following€ways€(regardless€of€whether€or€not€the€Beneficiary€is€a€minor€or€is€incapacitated):€(a)€To€theÏBeneficiary€directly;€(b)€To€the€guardian€of€the€Beneficiaryððs€person€or€estate;€(c)€By€reimbursing€the€personÏwho€is€actually€taking€care€of€the€Beneficiary,€even€though€the€person€is€not€the€legal€guardian,€for€expendituresÏmade€by€the€person€for€the€benefit€of€the€Beneficiary;€or€(d)€By€paying€for€a€good€or€service€directly€to€theÏprovider€of€that€good€or€service.ÌÌà  à5.à ` àò òTermination€of€Trust.ó ó€€The€Trust€will€terminate€on€the€death€of€the€Beneficiary.Ð d´ ÐÌà  à6.à ` àò òDistribution€Upon€Termination€of€Trust.€€ó óUpon€termination€of€the€Trust,€the€trustee€shallÐ  Z Ðdistribute€the€principal€and€any€undistributed€income€of€the€Trust€to€the€Beneficiaryððs€descendants,€per€stirpes,Ïand€if€the€Beneficiary€has€no€descendants€who€are€then€living,€to€Settlorððs€descendants,€per€stirpes,€and€if€noneÏof€such€persons€is€then€living,€to€Settlorððs€heirs€at€law.ÌÌà  à7.à ` àò òCompensation€of€the€Trustee.ó ó€€The€Trustee€shall€be€entitled€to€reasonable€compensation,Ð &v Ðwhich€compensation€shall€not€exceed€that€customarily€charged€by€corporate€fiduciaries€in€____________,€Texas.€ÏIn€addition,€the€Trustee€may€be€reimbursed€from€the€trust€estate€for€expenses€it€reasonably€incurs.ÌÌà  à8.à ` àò òPowers€of€Trustee.ó ó€€The€Trustee€shall€have€all€of€the€powers€of€trustees€under€the€Texas€TrustÐ p!À# ÐCode.€€The€terms€and€provisions€of€the€Texas€Trust€Code€shall€apply€to€this€Trust,€to€the€extent€they€are€not€inÏconflict€with€the€terms€of€this€instrument.ÌÌà  à9.à ` àò òNo€Bond€Required.ó ó€€The€Trustee€shall€serve€without€giving€a€bond.Ð º$ ' ÐÌà  à10.à ` àò òSuccessor€Trustees.ó ó€€If€the€Trustee€resigns,€________________€shall€become€successorÐ `&°!) ÐTrustee.€€Each€successor€trustee€shall€have€all€of€the€rights,€powers€and€duties€of€the€Trustee.ÌÌà  à11.à ` àò òSpendthrift€Trust.ó ó€€To€the€extent€permitted€by€law,€the€interest€of€the€Beneficiary€shall€be€heldÐ Ø(($, Ðsubject€to€a€spendthrift€trust€as€provided€in€Section€112.035€of€the€Texas€Property€Code.ÌÌà  àSigned€this€____€day€of€_____________,€____.ÌÌ___________________________________ÌSettlorÐ Æ-)2 Ї___________________________________ÌTrusteeññññññññÔ#†”‚¶§s#ÔÔ#†XÂ0X”‚¶#Ôññññ