Capital Credits Division Agreement

CAPITAL CREDITS DIVISION AGREEMENT
I,
And I,
to equally divide the unretired capital credis on member number
earned between the years of
In the amount of
and/or all outstanding checks in the total amount of
PLEASE NOTE: CAPITAL CREDIT AMOUNTS ARE PAID OUT AS THE BOARD OF DIRECTORS RETIRES EACH YEAR. YOU WILL NOT BE RECEIVING THE WHOLE AMOUNT AT THIS TIME.
Full Name

Street Address

City, StateZip Code

Signature
Full Name

Street Address

City, StateZip Code

Signature
________________________________________

Signature
________________________________________

Signature
Subscribed and sworn to before me this

_____ day of __________, 20____

_________________________________

Notary Public

NOTARY SEAL
Subscribed and sworn to before me this

_____ day of __________, 20____

_________________________________

Notary Public

NOTARY SEAL
Office Use Only:

Received Date:

Process Date:

Employee:
Should be Empty:

CAPITAL CREDITS DIVISION AGREEMENT