Capital Credits Estate Closing Agreement

CAPITAL CREDITS ESTATE CLOSING AGREEMENT
RE: CAPITAL CREDITS FOR
Enclosed is the detailed listing of the unretired capital credit history for
Heart of Iowa Communications Cooperative has allocated
in unretired capital credits to Member #
as of
The Executor/Trustee will have the following options:

a. Leave as is and receive capital credits as each year is retired at the Board of Directorsb. Wait until April of __________ when Heart of Iowa allocates _________________ to receive all allocations at a discounted amount, if applicablec. Waive allocations for __________ and close the account in the discounted amount of $_______________.
_________________________________________        Payee (please list mulitple payees on reverse)

_________________________________________            Address

_________________________________________             City, State, Zip
_________________________________________        Executor/Trustee

_________________________________________                     Date

_________________________________________            Executor/Trustee

_________________________________________             Date
By my signature above, I aggree to hold harmless and indemnify Heart of Iowa Communications Cooperative against any and all claims by virtue of the payment of the capital credits owed on the fore mentioned account paid to the payee indicated above.
After electing one of the above options, please complete the payee, address, and signature section. Further, please include a copy of the Appointment letter or Last Will & Testament with the return of this letter. Your request will be processed within thrity days of receitp, any outstanding retirement checks will also be re-issued at that time.

If you have further questions, please call 641-486-2211 or email kfaris@heartofiowa.coop.
Office Use Only:

Received Date:

Process Date:

Employee:
Should be Empty:

CAPITAL CREDITS ESTATE CLOSING AGREEMENT