Membership Equity Donation

Name(s) or Company

Pursuant to Article VIII, Section 4 of the Trico Electric Cooperative, Inc. (Trico) Bylaws, I (We), hereby irrevocably assign and donate to the Trico Foundation, an (Name(s) or Company)Arizona corporation designated by the Internal Revenue Service as a 501(c)(3), Not-for-Profit organization, all rights, title and interest in 100% of the Membership Equity (patronage capital credits) which have been or which may in the future be assigned or credited to me by Trico as hereafter indicated

I/we would like to donate:

(Please check all appropriate boxes)

All past years’ assignments

Yes

Current year’s assignments

Yes

All future assignments

Yes

Other

By signing below, I (we) certify that I (we) have any and all rights necessary to make such donation and no other person or entity has any interest in or right to the Membership Equity (patronage capital credits) being donated herein, and that I (we) am not relying on any promise or representation from Trico or the Trico Foundation in making this donation.

Signature

Signature (If Joint Account)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Account Number