WHEREAS, the undersigned was a joint owner of capital credits issued to him/her and his/her spouse

     WHEREAS, the undersigned has provided a copy of the divorce decree and has requested that the capital credits assigned to the joint account be changed to reflect the divorce by one of the following options;

_____ B. Said decree does not provide for a distribution of the capital credits and the undersigned represents that the same constitute marital property and has requested equal division of the capital credits into separate accounts for each former spouse.

NOW, THEREFORE, the undersigned agrees as follows:

The undersigned covenants and agrees to indemnify and hold Heart of Iowa Communications Cooperative harmless from any and all claims of any kind, nature or description which may result from the receipt and allocation of unpaid capital credits in accordance with this agreement; and includes but is not limited to, responsibility to the undersigned’s former spouse, claims of creditors, and the claims of any personal representatives, successors or assigns claiming through the former spouse.

Subscribed and sworn to before me this

In accordance with the foregoing, Heart of Iowa Communications Cooperative, agrees to assign the capital credits as set forth therein as a result of the dissolution of his/her marriage.

FOR OFFICE USE ONLY:  In accordance with the foregoing, Heart of Iowa Communications Cooperative, agrees to assign the capital credits as set forth therein as a result of the dissolution of his/her marriage.

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Employee                                                        Date