University of Virginia Library

WITNESSETH:

1. The Trustee acknowledges receipt of the property listed on Exhibit A attached hereto and having a fair market value as of the date hereof of $____________________ as an irrevocable gift from the Donor, which property and all additions thereto shall be held, administered and distributed in trust as hereinafter provided.

2. This gift shall be designated on the books and records of the Trustee as the [Donor] Fund (the Fund).

3. The Donor may at any time make additional contributions to the Fund by deed, gift or will with the consent of the Trustee.

4. The fund shall become a part of the University of Virginia Pooled Income Fund (the Pool) and be held, administered and distributed in accordance with the agreement between The Rector and Visitors of the University of Virginia (the Institution) and the Trustee dated May _____, 1976, creating the Pool, a copy of which agreement is attached hereto and hereby incorporated by reference.

5. The Donor hereby retains for himself for and during his life an income interest in the property transferred to the Pool. Such income interest shall consist of units of participation in the Pool, and payments of income thereon shall be made in accordance with the agreement attached hereto. Until the Trustee determines that payments shall be made more or less frequently or at other times, the Trustee shall make income payments to the Donor in four quarterly payments on or about March 15, June 15, September 15 and December 15 of the taxable year of the Pool, with an adjusting payment being made, if necessary, during the taxable year or within the first 65 days following its close to bring the total payment to the actual income to which he was entitled for that year, all as more fully provided in Paragraph 8 of the agreement creating the Pool.

6. Upon the death of the Donor, the Trustee of the Pool shall sever from the Pool an amount equal to the

value of the remainder interest in property upon which the income interest is based and transfer it to The Rector and Visitors of the University of Virginia [alternate clauses - use only one:]

[A - principal and income unrestricted] to be used in such manner as it may direct.

[B - permanent fund-income unrestricted] to constitute an endowment fund which shall continue to be known as the [Donor] Fund, such Fund to be kept invested by The Rector and Visitors of the University of Virginia and the annual income thereof used in such manner as it may direct.

[C - permanent fund-income restricted] to constitute an endowment fund which shall continue to be known as the [Donor] Fund, such Fund to be kept invested by The Rector and Visitors of the University of Virginia and the annual income thereof used to [state purpose; for example, faculty salaries, scholarships, etc.].

7. The Trustee shall have the power, acting alone, to amend this Agreement in any manner necessary for the sole purpose of insuring that the Fund qualifies as a gift to a pooled income fund within the meaning of

§ 642(c)(5) of the Internal Revenue Code of 1954, or corresponding provision of any subsequent Federal tax law. Anything herein to the contrary notwithstanding, the assets of the Fund shall not be subject to claims for any Federal, State or other estate, inheritance or succession taxes or duties which may be assessed against the estate of the Donor, and the Donor hereby agrees that any and all such taxes and duties payable with respect to any assets included in the Fund shall be paid out of such assets of the Donor's estate as are subject to administration and not out of the assets of the Fund, and that the Donor shall not make any inconsistent direction in his will.

8. This Agreement shall be effective only upon execution by the Trustee at its offices in Richmond, Virginia.