Privacy notice

This form asks for sensitive personal information, including your date of birth and your Emmonak certificate number. It is sent over a secure, encrypted connection to records@emmonak.com for processing this request. If you would prefer not to enter this information online, download the PDF version and mail the signed original to Emmonak Corporation, P.O. Box 49, Emmonak, AK 99581.

Important — this form creates a draft only.

To make your Will legally effective for ANCSA share transfer, print the completed draft, sign it before two adult witnesses, and have it notarized or postmarked by a U.S. Postmaster. Mail the signed original to Shareholder Records.

1 · Testator (you)

Full legal name

Any other names used (maiden, married, aliases) (optional)

Emmonak certificate number🔒 SENSITIVE

Number of shares (optional)

Date of birth🔒 SENSITIVE

Spouse's full name (if any) (optional)

Phone

2 · Children (informational)

3 · Beneficiaries

Primary beneficiary percentages must total 100%. If you name contingent beneficiaries, their percentages must separately total 100%.

Beneficiary #1

Beneficiary type

Primary beneficiary

Contingent beneficiary

Full legal name

Relationship to you

Date of birth (optional)🔒 SENSITIVE

% of shares

Alaska Native?

Yes

Mailing address (street, city, state, ZIP)

4 · If a beneficiary predeceases you

How should that beneficiary's share be distributed?

The predeceased beneficiary's descendants (children or grandchildren if children are not living)

The surviving beneficiaries on a pro-rata basis

The following named alternate beneficiary or beneficiaries:

5 · Children born or adopted after this Will

Include children born to you or adopted-in after this Will?

Yes — in a percentage as equal as possible to other beneficiaries

Include children born to you and adopted-out after this Will?

Yes — in a percentage as equal as possible to other beneficiaries

6 · Custodian for minor beneficiaries (optional)

7 · Special instructions and execution

8 · Sworn statements

I understand the signed original must be notarized or postmarked and mailed to Emmonak Corporation.

Last Will & Testament — ANCSA Stock Will