NO. ______

__________________________, AS	§	IN THE DISTRICT COURT OF

GUARDIAN AD LITEM FOR	§

________________________,	§

[A MINOR] [AN INCAPACITATED PERSON],	§

Plaintiff,	§

§	____________ COUNTY, TEXAS,

v.	§

§

__________________________,	§

Defendant	§	____ JUDICIAL DISTRICT

COURT-CREATED TRUST FOR _______________________

This declaration of trust creates a trust (the "Trust") for the benefit of ____________________ (the "Beneficiary"), [a minor][an incapacitated person (within the meaning of Tex. Prop. Code §142.007)] with __________________ (the "Trustee") as trustee.

a.	Authority for Creation. This Trust is created by the order of the District Court of _____________ County, Texas, ____ Judicial District (the "Court") in Cause No. _________, styled ___________________________, as Guardian Ad Litem for ________________________, [a Minor][an Incapacitated Person], v. ________________________________, pursuant to Tex. Prop. Code § 142.005.

b.	Transfer to Trust.	The initial trust estate of the Trust shall be the property described on Schedule "A" attached hereto. Additional property acceptable to the Trustee may be transferred to the Trust from time to time and added to the trust estate.

c.	Distributions During Term of Trust. The Beneficiary shall be the sole beneficiary of the Trust. Prior to termination of the Trust, the Trustee may disburse that amount of the Trust's principal, income, or both as the Trustee in its sole discretion determines to be reasonably necessary for the health, education, support, or maintenance of the Beneficiary. Distributions, payments, uses, and applications of all trust funds may be made to the legal or natural guardian of the Beneficiary or to the person having custody of the Beneficiary or may be made directly to or expended for the benefit, support, or maintenance of the Beneficiary without the intervention of any legal guardian or other legal representative of the Beneficiary. The income of the Trust that the Trustee does not disburse or under this section must be added to the principal of the Trust.

d.	Termination of Trust. The Trust will terminate on the earlier of: (a) the death of the Beneficiary; or (b) [on the Beneficiary's twenty-fifth (25th) birthday][when the Beneficiary regains capacity (within the meaning of Tex. Prop. Code §142.007]. The Trust also may be terminated in whole or in part at any time by order of the Court.

e.	Distribution Upon Termination of Trust. Upon termination of the Trust, the trustee shall distribute the principal and any undistributed income of the Trust to the Beneficiary, outright and free of trust, or, if the Beneficiary is then deceased, to the representative of the deceased Beneficiary's estate.

If This is a (d)(4)(A) trust, use the following alternative paragraphs c., d. and e. instead

c.	Distributions During Term of Trust. The following provisions shall govern distributions from the Trust during the term of this Trust:

1.	Purpose and Intent. This Trust is created pursuant to 42 U. S. C. §1396p(d)(4)(A). It is intended to be construed and administered as a "supplemental needs" trust under 42 U. S. C. §1396p(d)(4)(A). Without limiting the foregoing, neither the corpus of the Trust nor distributions from the Trust shall ever cause the Beneficiary to be disqualified to receive those public benefits or assistance under a state or federal program to which the Beneficiary then may be entitled but for the existence of this Trust or but for the distributions from this Trust.

2.	Distribution Standard. During the term of this Trust, the Trustee shall apply for the benefit of the Beneficiary those amounts of the principal and/or income of the Trust for the satisfaction of the Beneficiary's supplemental needs (defined below), as the Trustee, in the Trustee's sole and absolute discretion, may from time to time deem appropriate, subject to the strict limitations set out in this instrument. Any income of the trust not distributed shall be added to the principal. Distributions, payments, uses, and applications of all trust funds may be made to the legal or natural guardian of the Beneficiary or to the person having custody of the Beneficiary or may be expended directly for the benefit of the Beneficiary without the intervention of any legal guardian or other legal representative of the Beneficiary.

3.	Supplemental Needs. As used in this instrument, "supplemental needs" refers to the requisites, as allowed for in 42 U. S. C. §1396p(d)(4)(A), for maintaining the Beneficiary's health, safety, and welfare when the Trustee determines, in its discretion, that such needs are not being provided for by any public or private agency, including any state, the United States, or any insurance carrier with insurance policies covering the Beneficiary. The Trustee is prohibited from expending any of the trust principal or income for any property, services, benefits, or medical care which are being received by, or which are otherwise available to, the Beneficiary from any governmental source or from any insurance carrier required to cover the Beneficiary. Further, the Trustee is prohibited from expending any of the trust principal or income for any such property, services, benefits, or medical care if that restriction is necessary in order to qualify the Beneficiary for such governmental or insurance carrier benefits because an application for such property, services, benefits, or medical care has been filed with an applicable governmental agency or insurance carrier on the Beneficiary's behalf. The Trustee may pay any deductible amounts for the Beneficiary on any insurance policies covering the Beneficiary so long as that payment does not disqualify the Beneficiary from receipt of benefits. The Trustee shall cooperate with the Beneficiary's conservator, guardian, or legal representative to seek support and maintenance for the Beneficiary from all available resources, including but not limited to, the Supplemental Social Security Income Program (SSI), Supplemental Income Program (SIP) of Texas, the Old Age Survivor and Disability Insurance Program (OASDI), the Medicaid Program, and any additional similar or successor programs, and from any private sources. To the extent required by 42 U. S. C. §1396p(d)(4)(A) and other applicable laws and regulations regarding trusts of this type, the Trustee may supplement, but shall not supplant, services, benefits, and medical care received or requested by or on behalf of the Beneficiary that are available through any governmental or private resource.

4.	Payment of Income Taxes. The Trustee shall pay any income tax liability of the Beneficiary which results from income received by the Trust but reported on the income tax return of the Beneficiary. The funds used to pay this income tax liability shall be paid directly to the appropriate taxing authority and shall not be available to the Beneficiary. The Beneficiary shall not have any right to or interest in any of these funds paid by the Trustee. Further, these funds are not a resource of the Beneficiary and shall not be treated as a distribution of cash for purposes of Medicaid qualification.

d.	Termination of Trust. The Trust will terminate on the death of the Beneficiary. The Trust also may be terminated in whole or in part at any time by order of the Court.

e.	Distribution Upon Termination of Trust. Upon termination of the Trust, the trustee shall distribute the principal and any undistributed income of the Trust as follows:

1.	First, the Trustee shall pay all amounts required to be reimbursed pursuant to 42 U. S. C. §1396p(d)(4)(A). The Trustee shall reimburse those states where the Beneficiary has received Medical Assistance payments from the state, based upon the state's proportionate share of the total amount of Medicaid benefits paid by all of the states on the Beneficiary's behalf, the smallest amount (if any) as applicable law then requires the Trust to pay. The Trustee's duty to reimburse the state upon termination shall apply to the extent there are remaining assets in this trust and shall apply irrespective of any other provision of this instrument. The Trustee shall reimburse the state only for those benefits provided to the Beneficiary which are subject to such reimbursement claim.

2.	After the satisfaction of these obligations, the Trustee shall distribute the remaining property, if any, to the Beneficiary, outright and free of trust, or, if the Beneficiary is then deceased, to the representative of the deceased Beneficiary's estate.

f.	Compensation of the Trustee. The Trustee is entitled to reasonable compensation paid from the Trust's income, principal, or both on application to and approval of the Court. Unless otherwise ordered by the Court, the fees and other charges described on the Trustee's then- current fee schedule are hereby approved by the Court as reasonable compensation to the Trustee, and the Trustee is entitled to pay itself such fees and other charges without further application to or approval of the Court. In addition, the Trustee may be reimbursed from the trust estate for expenses it reasonably incurs in connection with the Trust.

g.	Powers of Trustee. The Trustee shall have all of the powers of trustees under the Texas Trust Code. The terms and provisions of the Texas Trust Code shall apply to this Trust, to the extent they are not in conflict with Tex. Prop. Code § 142.005 or with the terms of this instrument.

h.	No Bond Required. The Trustee shall serve without giving a bond.

i.	Successor Trustees. In the event of the corporate reorganization, merger or acquisition of the Trustee, the resulting successor organization shall automatically become the successor trustee. The Trustee may resign with the approval of the Court and may be removed by order of the Court. Upon the resignation or removal of the Trustee, the Court shall appoint a successor trustee. Each successor trustee shall have all of the rights, powers and duties of the Trustee.

j.	Spendthrift Trust. To the extent permitted by law, the interest of the Beneficiary shall be held subject to a spendthrift trust as provided in Section 112.035 of the Texas Property Code.

k.	Amendment, Modification or Revocation. The Court may amend, modify, or revoke the Trust at any time before the date of the Trust's termination. Neither the Beneficiary nor the guardian of the Beneficiary's estate may revoke the Trust.

l.	Effective Date. This Trust shall be effective upon the last to occur of (A) the entry of an order creating the Trust by the Court, (B) the execution of this Declaration of Trust by the Trustee indicating its acceptance of the Trust; and (C) the receipt by the Trustee of the initial trust estate.

TRUSTEE'S ACCEPTANCE:

By:_______________________

Name:_____________________

Title:______________________