Exhibit 10.7


 


FORM OF


THE FIRST NATIONAL BANK OF MARYSVILLE


DIRECTOR DEFERRED FEE AGREEMENT


 


THIS AGREEMENT is made this       day of                             , 20    ,by THE FIRST NATIONAL BANK OF MARYSVILLE,
a national bank located in Marysville, Pennsylvania (the “Bank”), and, (the “Director”).


 


INTRODUCTION


 


To encourage the Director to remain a member of the Bank’s Board of Directors,
the Bank is willing to provide to the Director a deferred fee opportunity.  The Bank will pay the benefits from its general
assets.


 


AGREEMENT


 


The Director and the Bank agree as follows:


 


Article 1


Definitions


 


1.1  Definitions.  Whenever used in this Agreement, the
following words and phrases shall have the meanings specified:


 


1.1.1  “Change in
Control” means any of the following:


 


(a)  (A) a merger, consolidation or division involving
corporation, (B) a sale, exchange, transfer or other disposition of
substantially all of the assets of Corporation, or (c) a purchase by
Corporation of substantially all of the assets of another entity, unless after
such merger, consolidation, division, sale, exchange, transfer, purchase or
disposition a majority of the members of the Board of Directors of the legal
entity resulting from or existing after any such transaction and of the Board
of Directors of such entity’s parent corporation, if any, are former members of
the Board of Directors of Corporation; or


 


(b)  any “person” (as such term is used in Sections 13(d) and
14(d) of the Securities Exchange Act of 1934 (the “Exchange Act”), other
than Corporation or Bank or any “person” who on the date hereof is a director or
officer of Corporation or Bank is or becomes the “beneficial owner” (as defined
in Rule 13d-3 under the Exchange Act), directly or indirectly, of securities
of Corporation or Bank representing thirty-five (35%) percent or more of the
combined voting power of Corporation’s or Bank’s then outstanding securities,
or


 

















 


(c)  during any period of one (1) year during the term of
Executive’s employment under this Agreement, individuals who at the beginning
of such period constitute the Board of Directors of Corporation or Bank cease
for any reason to constitute at least a majority thereof: unless the election
of each director who was not a direct or at the beginning of such period has
been approved in advance by directors representing at least two-thirds of the
directors then in office who were directors at the beginning of the period.


 


Notwithstanding anything else to the contrary set forth in this
Agreement, if (i) an Agreement is executed by the Corporation providing
for any of the transactions or events constituting a Change in Control as
defined herein, and the Agreement subsequently expires or is terminated without
the transaction or event being consummated, and (ii) Director’s service
did not terminate during the period after the Agreement and prior to such
expiration or termination, for purposes of this Agreement, it shall be as
though such Agreement was never executed and no Change in Control event shall
be deemed to have occurred as a result of the execution of such Agreement.


 


1.1.2 “Code” means the Internal Revenue
Code of 1986, as amended.


 


1.1.3  “Corporation”
means First Perry Bancorp, Inc.


 


1.1.4  “Disability”
shall mean the Executive is unable to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment
that can be expected to result in death or can be expected to last for a
continuous period of not less than 12 months. The executive will be deemed
disabled if the Social Security Administration has determined that he is
disabled or if a carrier of any group disability insurance policy provided by
the Bank or made available by the Bank to its employees and covering the
Director determines that he is disabled as long as the policy’s definition of
disability complies with the definition of disability under IRC Section 409A.


 


1.1.5  “Election
Form” means the Form attached as Exhibit A.


 


1.1.6  “Fees”
means the total amount earned by the Director for serving on the Bank’s Board.


 


1.1.7  “Normal
Benefit Age” means the benefit distribution age specified by the
Director in Exhibit A.


 


1.1.8  “Plan Year”
means each twelve (12) month period commencing with the month deferrals
commence under this Agreement.


 

















 


1.1.9  “Termination
of Service” means the Director’s ceasing to be a member of the Bank’s
Board of Directors for any reason other than death.


 


Article 2


Deferral Election


 


2.1  Initial Election.  The Director shall make an initial deferral
election under this Agreement by filing with the Bank a signed Election Form within
thirty (30) days after the date of this Agreement.  The Election Form shall set forth the
amount of Fees to be deferred, provided such deferral opportunity shall be
limited to Fees earned during the ten-year period ending,           ,
20   , unless an extension is approved in
writing by the Bank.  The Election Form shall
be effective to defer only Fees earned after the date the Election Form is
received by the Bank.


 


2.2  Election Changes.  The Director may modify the amount of Fees to
be deferred annually by filing a new Election Form with the Bank.  The modified deferral shall not be effective
until the calendar year following the year in which the subsequent Election Form is
received by the Bank.  Any changes to the
form of benefit payment must be in accordance with Exhibit A.


 


Article 3


Deferral Account


 


3.1  Establishing and
Crediting.  The Bank shall
establish a Deferral Account on its books for the Director and shall credit to
the Deferral Account the following amounts:


 


3.1.1  Deferrals.  The Fees deferred by the Director as of the
time the Fees would have otherwise been paid to the Director.


 


3.1.2  Interest.  Interest at an annual rate of 70% of R.O.E.
R.O.E. is to be calculated by a daily quarterly average.


 


3.2  Statement of Accounts.  The Bank shall provide to the Director,
within one hundred twenty (120) days after each Plan Year, a statement setting
forth the Deferral Account balance.


 


3.3 Accounting Devise Only.  The Deferral Account is solely a device for measuring
amounts to be paid under this Agreement. 
The Deferral Account is not a trust fund of any kind.  The Director is a general unsecured creditor
of the Bank for the payment of benefits. 
The benefits represent the mere Bank promise to pay such benefits.  The Director’s rights are not subject in any
manner to anticipation, alienation, sale, transfer, assignment, pledge,
encumbrance, attachment or garnishment by the Director’s creditors.


 

















 


Article 4


Lifetime Benefits


 


4.1  Normal Benefit Age.  If the Director terminates service as a
Director on or after Normal Benefit Age, the Bank shall pay to the Director the
benefit described in this Section 4.1 in lieu of any other benefit under
this Agreement.


 


4.1.1  Amount of Benefit.  The benefit under this Section 4.1 is
the Deferral Account balance at the date specified in Exhibit A.


 


4.1.2  Payment of Benefit.  The Bank shall pay the benefit to the
Director in the form specified in Exhibit A.  If installment payments are elected, the Bank
shall continue to credit interest at an annual rate as defined in Section 3.1.2
above, on the undistributed account balance during any applicable installment
period.


 


4.2  Early Termination
Benefit.  If the Director
terminates service as a Director before the Normal Benefit Age for reasons
other than death, disability or following a Change in Control, the Bank shall
pay to the Director the benefit described in this Section 4.2 in lieu of any
other benefit under this Agreement.


 


4.2.1  Amount of Benefit.
 The Benefit under this Section 4.2
is the Deferral Account balance at the Director’s Termination of Service.


 


4.2.2  Payment of Benefit.
 The Bank shall pay the benefit to the
Director in the form specified in Exhibit A. If installment payments are
elected, the Bank shall continue to credit interest at an annual rate as
defined in Section 3.1.2 above, on the undistributed account balance
during any applicable installment period.


 


4.3  Disability Benefit.
 Upon termination of Service for
disability prior to the Normal Benefit Age, the Bank shall pay to the Director
the benefit described in this Section 4.3 in lieu of any other benefit
under this Agreement.


 


4.3.1  Amount of Benefit.
 The benefit under this Section 4.3
is the Deferral Account balance at the date specified in Exhibit A.  If applicable, the Bank shall continue to
credit interest to the Deferral Account balance at a rate as defined in Section 3.1.2
above, during the period from Termination of Service until payments commence.


 


4.3.2  Payment of Benefit.
 The Bank shall pay the benefit to the
Director in the form specified in Exhibit A. If installment payments are elected
the Bank shall continue to credit interest at an annual rate as defined in 


 

















 


Section 3.1.2 above on the undistributed
account balance during any applicable installment period.


 


4.4  Change of Control
Benefit.  If the Director is
in the active service of the Bank when the change occurs, the Bank shall pay to
the Director the benefit described in this Section 4.4 in lieu of any other
benefit under this Agreement.


 


4.4.1  Amount of Benefit.
 The benefit under this Section 4.4
is the Deferral Account balance at the date specified in Exhibit A.  If applicable, the Bank shall continue to
credit interest to the Deferral Account balance at a rate as defined in Section 3.1.2
above, during the period from Termination of Service until payments commence.


 


4.4.2  Payment of Benefit.
 The Bank shall pay the benefit to the
Director in the form specified in Exhibit A. If installment payments are
elected, the Bank shall continue to credit interest at an annual rate as
defined in Section 3.1.2 above, on the undistributed account balance
during any applicable installment period.


 


4.5  Hardship
Distribution.  If an
unforeseeable financial emergency arising from the death of a family member,
divorce, sickness, injury, catastrophe or similar event outside the control of the
Director occurs, the Director may petition the Board for early payout of his
Deferral Account.  If the Board
determines that the Director’s request constitutes an unforeseeable financial
emergency, the Bank shall distribute to the Director all or a portion of the
Deferral Account balance as determined by the Bank, but in no event shall the
distribution be greater than is necessary to relieve the financial hardship.  The Board of Directors shall determine whether
the request constitutes an unforeseeable financial emergency in accordance with
the definition of hardship under IRC Section 409A.


 


4.6  Notwithstanding
any other provision, in the event that Executive is determined to be a
specified employee as that term is defined in Section 409A of the Code, no
payment that is determined to be deferred compensation subject to Section 409A
of the Code shall be made before the first day of the seventh month from the date
of separation of service as that term is defined in Section 409A of the
Code.


 


Article 5


Death Benefits


 


5.1  Death Prior to
Commencement of Benefit Payments.  If the Director dies prior to commencement of benefit
payments, the Bank shall pay to the Director’s beneficiary the benefit
described in this Section 5.1 in lieu of any other benefit under this
Agreement.


 

















 


5.1.1  Amount of Benefit.
 The benefit amount under Section 5.1
is the Deferral Account balance.


 


5.1.2  Payment of Benefit.
 The Bank shall pay the benefit to the beneficiary
in the form specified in Exhibit A, with payment made or commencing on the
first day of January following the Director’s death.  If installment payments are elected, the Bank
shall continue to credit interest at an annual rate as defined in Section 3.1.2
above, compounded monthly, on the undistributed account balance during any
applicable installment period.


 


5.2 Death During
Benefit Period.  If the
Director dies after benefit payments have commenced under this Agreement, but
before receiving all such payments, the Bank shall pay the remaining benefits
to the Director’s beneficiary at the same time and in the same amounts they
would have been paid to the Director had the Director survived.


 


Article 6


Beneficiaries


 


6.1  Beneficiary
Designations. The Director shall designate a beneficiary by filing a
written designation with the Bank. The Director may revoke or modify the
designation at any time by filing a new designation. However, designations will
only be effective if signed by the Director and accepted by the Bank during the
Director’s lifetime. The Director’s beneficiary designation shall be deemed automatically
revoked if the beneficiary predeceases the Director, or if the Director names a
spouse as beneficiary and the marriage is subsequently dissolved.  If the Director dies without a valid
beneficiary designation, all payments shall be made to the Director’s estate.


 


6.2  Facility of Payment.
 If a benefit is payable to a minor, to a
person declared incompetent, or to a person incapable of handling the disposition
of his or her property, the Bank may pay such benefit to the guardian, legal
representative or person having the care or custody of such minor, incompetent
person or incapable person.  The Bank may
require proof of incompetence, minority or guardianship as it may deem
appropriate prior to distribution of the benefit.  Such distribution shall completely discharge
the Bank from all liability with respect to such benefit.


 


Article 7


General Limitations


 


Notwithstanding any provision of this Agreement to the contrary, the
Bank shall not pay any benefit under this Agreement that is attributable to the
interest earned on such contributions.


 

















 


7.1  Excess Parachute
or Golden Parachute Payment.  To
the extent the benefit would be an excess parachute payment under Section 280G
of the Code or would be a prohibited golden parachute payment pursuant to 12
C.F.R 359.2 and for which the appropriate federal banking agency has not given
written consent to pay pursuant to 12 C.F.R. 359.4.


 


 7.2  Termination for Cause.  If the
Bank terminates the Director’s service for:


 


7.2.1  Gross
negligence or gross neglect of duties;


 


7.2.2  Commission
of a felony or of a gross misdemeanor involving moral turpitude; or


 


7.2.3  Fraud,
disloyalty, dishonesty or willful violation of any law or significant Bank
policy committed in connection with the Director’s service and resulting in an
adverse effect on the Bank.


 


7.3  Removal.  If the Director is subject to a final removal
or prohibition order issued by an appropriate federal banking agency pursuant to
Section 8(e) of the Federal Deposit Insurance Act.


 


7.4  Competition After
Termination of Service.  If the
Director, without the prior written consent of the Bank engages in, becomes
interested in, directly or indirectly, as a sole proprietor, as a partner in a
partnership, or as a substantial shareholder in a corporation, or becomes
associates with, in the capacity of employee, director, officer, principal,
agent, trustee or in any other capacity whatsoever, any enterprise conducted in
the trading area (a 50 mile radius of the main office of the Corporation),
which enterprise is, or may deemed to be, competitive with any business carried
on by the Corporation as of the date of termination of the Director’s service
or his retirement.  This section shall
not apply following a Change in Control.


 


7.5  Suicide.  If the Director commits suicide within
two years after the date of this Agreement, or if the Director has made any
material misstatement of fact on any application for life insurance purchased
by the Bank.


 


Article 8


Claims and Review Procedures


 


8.1 Claims Procedure.
 The Bank shall notify any person or
entity that makes a claim against the Agreement (the “Claimant”) in writing,
within ninety (90) days of Claimant’s written application for benefits, of Claimant’s
eligibility or ineligibility for benefits under the Agreement.  If the Bank determines that the Claimant is not
eligible for benefits or full benefits, the notice shall set forth (1) the
specific reasons for such denial, (2) a specific reference to the
provisions of the Agreement on which the denial is based, (3) a
description of any additional 


 

















 


information or material necessary for the Claimant to perfect Claimant’s
claim, and a description of why it is needed, and (4) an explanation of
the Agreement’s claims review procedure and other appropriate information as to
the steps to be taken if the Claimant wishes to have the claim reviewed.  If the Bank determines that there are special
circumstances requiring additional time to make a decision, the Bank shall notify
the Claimant of the special circumstances and the date by which a decision is
expected to be made, and may extend the time for up to an additional ninety-day
period.


 


8.2  Review Procedure.
 If the Claimant is determined by the
Bank not to be eligible for benefits, or if the claimant believes that claimant
is entitled to greater or different benefits, the Claimant shall have the
opportunity to have such claim reviewed by the Bank by filing a petition for
review with the Bank within sixty (60) days after receipt of the notice issued
by the Bank.  Said petition shall state
the specific reasons which the Claimant believes entitle Claimant to benefits
or to greater or different benefits.  Within
sixty (60) days after receipt by the Bank of the petition, the Bank shall
afford the claimant (and counsel, if any) an opportunity to present Claimant’s
position to the Bank orally or in writing, and the Claimant (and counsel) shall
have the right to review the pertinent documents.  The Bank shall notify the Claimant of it’s decision in writing within the sixty-day period,
stating specifically the basis of its decision, written in a manner calculated
to be understood by the Claimant and the specific provisions of the Agreement
on which the decision is based.  If,
because of the need for a hearing, the sixty-day period is not sufficient, the
decision may be deferred for up to another sixty-day period at the election of the
Bank, but notice of this deferral shall be given to the Claimant.


 


Article 9


Amendments and Termination


 


This Agreement may be amended or terminated only by a written Agreement
signed by the Bank and the Director, except as specified in Article 7.


 


Article 10


Miscellaneous


 


10.1  Binding Effect.
 This Agreement shall bind the Director
and the Bank and their beneficiaries, survivors, executors, administrators and
transferees.


 


10.2  No Guarantee
of Service.  This Agreement is
not a contract for services.  It does not
give the Director the right to remain a director of the Bank, nor does it interfere
with the shareholders’ rights to replace the Director.  It also does not require the Director to
remain a director nor interfere with the Director’s right to terminate service
at any time.


 

















 


10.3  Non-Transferability.
 Benefits under this Agreement cannot be
sold, transferred, assigned, pledged, attached or encumbered in any manner.


 


10.4  Tax Withholding.
 The Bank shall withhold any taxes that
are required to be withheld from the benefits provided under this Agreement.


 


10.5  Applicable Law.
 The Agreement and all rights hereunder
shall be governed by the laws of the Commonwealth of Pennsylvania, except to the
extent preempted by the laws of the United States of America.  This agreement is intended to be administered
in a manner consistent with the requirements, where applicable, of Section 409a
of the Code.


 


10.6  Unfunded Arrangement.
 The Director and beneficiary are general
unsecured creditors of the Bank for the payment of benefits under this
Agreement. The benefits represent the mere promise by the Bank to pay such
benefits.  The rights to benefits are not
subject in any manner to anticipation, alienation, sale, transfer, assignment,
pledge, encumbrance, attachment or garnishment by creditors.  Any insurance on the Director’s life is a
general asset of the Bank to which the Director and beneficiary have no
preferred or secured claim.


 


10.7  Recovery of Estate
Taxes.  If the Director’s
gross estate for federal estate tax purposes includes any amount determined by
reference to and on account of this Agreement, and if the beneficiary is other
than the Director’s estate, then the Director’s estate shall be entitled to
recover from the beneficiary receiving such benefit under the terms of the
Agreement, an amount by which the total estate tax due by the Director’s
estate, exceeds the total estate tax which would have been payable if the value
of such benefit had not been included in the Director’s gross estate.  If there is more than one person receiving
such benefit, the right of recovery shall be against each such person.  In the event the beneficiary has a liability
hereunder, the beneficiary may petition the Bank for a lump sum payment in an
amount not to exceed the beneficiary’s liability hereunder.


 


10.8  Entire Agreement.
 This Agreement constitutes the entire
agreement between the Bank and the Director as to the subject matter hereof.  No rights are granted to the Director by
virtue of this Agreement other than those specifically set forth herein.


 


10.9  Reorganization.  The Bank shall not merge or consolidate into
or with another company, or reorganize or sell substantially all of its assets
to another company, firm or person unless such succeeding or continuing
company, firm or person agrees to assume and discharge the obligations of the
Bank


 


10.10  Administration.  The Bank shall have powers which are necessary
to administer this Agreement, included, but not limited to:


 


10.10.1  Interpreting the
provisions of this Agreement.


 

















 


10.10.2  Establishing and
revising the method of accounting for the Agreement.


 


10.10.3  Maintaining a record
of benefit payments; and


 


10.10.4  Establishing rules and
prescribing any forms necessary or desirable to administer the Agreement.


 


10.11 Named Fiduciary.
 The Bank shall be the named fiduciary
and plan administrator under this Agreement.  The named fiduciary may delegate to others
certain aspects of the management and operation responsibilities of the plan
including the service of advisors and the delegation of ministerial duties to
qualified individuals.


 

















 


IN WITNESS WHEREOF, the Director and a duly authorized Bank officer
have signed this Agreement.


 


 


	
  DIRECTOR: 

  	
   

  	
  BANK:

  
	
   

  	
   

  	
  THE FIRST NATIONAL BANK OF

  
	
   

  	
   

  	
  MARYSVILLE

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Title

  	
   

  
						



 


 


By execution hereof; First Perry Bancorp, Inc. consents to and
agrees to be bound by the terms and conditions of this Agreement.


 


 


	
  ATTEST:

  	
   

  	
  CORPORATION:

  
	
   

  	
   

  	
  FIRST PERRY BANCORP, INC.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Title

  	
   

  
						



 

















 


EXHIBIT A


 


THE FIRST NATIONAL BANK OF MARYSVILLE


DIRECTOR DEFERRED FEE AGREEMENT


 


Election Form


 


Deferral
Election (Initial and Complete one):


 


	
   

  	
          I
  elect to defer     % of my fees for           
  months, increasing or decreasing to         %
  commencing in                   .
  20     .

  
	
   

  	
   

  	
  (mo./yr.)

  	
   

  
	
   

  	
   

  
	
   

  	
              I
  elect to defer $            per
  month for
              months,  increasing or
  decreasing to $            per
  month commencing             in      ,
  20      . 

  



 


Benefit
Age:


 


I
elect a Norman Benefit Age of       .


 


Timing
of Payout:


 


If
I terminate service after Normal Benefit Age, I elect to have my benefits
distributed commencing within 30 days of: (Initial One)


 


            Normal
Benefit Age


 


            Termination
of Service


 


 If I terminate service before Normal Benefit
Age due to Disability, I elect to have my benefits distributed commencing
within 30 days of: (Initial One)


 


            Normal
Benefit Age


 


            Termination
of Service


 


If
a Change in Control occurs prior to Normal Benefit Age, I elect to have my benefits
distributed commencing within 30 days of: (Initial One)


 


            Normal
Benefit Age


 


            Termination
of Service


 


            The
date the Change in Control occurs


 

















 


EXHIBIT A


 


THE FIRST NATIONAL BANK OF MARYSVILLE


DIRECTOR DEFERRED FEE AGREEMENT


 


CONTINUED


 


Form of
Payment:


 


I
elect to have my benefits paid in the following form (initial “a” or ‘‘b’’ for
each category):


 


	
  Section

  Reference

  	
   

  	
  Triggering

  Event

  	
   

  	
  Lump Sum

  	
   

  	
  Annuitized
  over

  120 Months

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4.1.2

  	
   

  	
  Normal
  Benefit Age

  	
   

  	
  (a)

  	
   

  	
  (b)

  	
   

  
	
  4.2.2

  	
   

  	
  Early
  Termination

  	
   

  	
  (a)

  	
   

  	
  (b)

  	
   

  
	
  4.3.2

  	
   

  	
  Disability

  	
   

  	
  (a)

  	
   

  	
  (b)

  	
   

  
	
  4.4.2

  	
   

  	
  Change
  in Control

  	
   

  	
  (a)

  	
   

  	
  (b)

  	
   

  
	
  5.1.2

  	
   

  	
  Death
  

  	
   

  	
  (a)

  	
   

  	
  (b)

  	
   

  



 


I
understand that I may change the form ofbenefit elected provided such change is
made at least 12 months prior to the date the payment becomes due.


 


 


	
  Signature:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Date:

  	
   

  	
   

  
				



 


 


Accepted
by the Bank this          day of                        ,
20    .


 


THE
FIRST NATIONAL BANK OF MARYSVILLE


 


 


	
  By:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Title:

  	
   

  	
   

  
				



 

















 


EXHIBITB


 


THE FIRST NATIONAL BANK OF MARYSVILLE


DIRECTOR DEFERRED FEE AGREEMENT


 


Planned Fee Deferrals


 


	
   

  	
   

  	
  (A) 

  	
   

  	
  (B)

  	
   

  
	
   

  	
   

  	
  Planned Annual 

  	
   

  	
  Planned Cumulative

  	
   

  
	
  Plan Year 

  	
   

  	
  Deferrals

  	
   

  	
  Deferrals

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  $

  	
  1,000.00

  	
   

  	
  $

  	
  1,000.00

  	
   

  
	
  2

  	
   

  	
   

  	
  $

  	
  1,000.00

  	
   

  	
  $

  	
  2,000.00

  	
   

  
	
  3

  	
   

  	
   

  	
  $

  	
  6,000.00

  	
   

  	
  $

  	
  8,000.00

  	
   

  
	
  4

  	
   

  	
   

  	
  $

  	
  6,000.00

  	
   

  	
  $

  	
  14,000.00

  	
   

  
	
  5

  	
   

  	
   

  	
  $

  	
  6,000.00

  	
   

  	
  $

  	
  20,000.00

  	
   

  
	
  6

  	
   

  	
   

  	
  $

  	
  6,000.00

  	
   

  	
  $

  	
  26,000.00

  	
   

  
	
  7

  	
   

  	
   

  	
  $

  	
  6,000.00

  	
   

  	
  $

  	
  32,000.00

  	
   

  



 

















 


THE FIRST NATIONAL BANK OF MARYSVILLE


DIRECTOR DEFERRED FEE AGREEMENT


 


Beneficiary Designation


 


I
designate the following as beneficiary of benefits under the Director Deferred
Fee Agreement payable following my death:


 


Primary
Beneficiary:


 


	
  Name:
  

  	
  Relationship:

  	
   

  
	
   

  	
   

  	
   

  
	
  Address:

  	
   

  	
   

  
	
   

  	
   

  	
   

  



 


Contingent
Beneficiary:  (to receive the benefits if there is no
surviving Primary Beneficiary)


 


	
  Name:
  

  	
  Relationship:

  	
   

  
	
   

  	
   

  	
   

  
	
  Address:

  	
   

  	
   

  
	
   

  	
   

  	
   

  



 


Note:                   To name a trust as beneficiary,
please provide the name of the trustee(s) and the  exact name and date of the trust
agreement.


 


I
understand that I may change these beneficiary designations by filing a new written
designation with the Bank.  I further
understand that the designations will be automatically revoked if the
beneficiary predeceases me, or, if I have named my spouse as beneficiary, in
the event of the dissolution of our marriage.


 


	
  Signature:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Date:

  	
   

  	
   

  
				



 


 


Accepted by the Bank this        day
of                   , 20   .


 


 


	
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  Title: