| Box # |
Entry |
| 1 |
Check “Tax Paid” |
| 2 |
Check “Corporation or other Business Entity” |
| 3b |
Husband and Wife Revocable Living Trust 1234 Circle Street CityVille, Ohio 45305 |
| 3d |
Greene |
| 3e |
(513) 555-5555 |
| 4a |
DoubleStar Corp. Winchester, KY |
| 4b |
Short Bbl Rifle |
| 4c |
5.56mm |
| 4d |
AR-15 |
| 4e |
11.5” |
| 4f |
29.5” |
| 4g |
00000001 |
| 4h |
Husband & Wife Trust CityVille, OH |
| 4i |
All legal purposes |
| 7a-e |
Check accordingly (better all be No) |
| 9 |
(Signature of Husband) |
| 10 |
Husband, Grantor and Trustee |
| 11 |
1-2-2008 (date signed) |