Exhibit 10.1


 
 
ALLIANT TECHSYSTEMS INC.
AMENDED AND RESTATED
NON-EMPLOYEE DIRECTOR RESTRICTED STOCK PLAN
 
Amended and Restated as of December 12, 2005
 
Section 1. Introduction
 
1.1 The Plan; Effective Date; Duration.  This Alliant Techsystems Inc. Amended and Restated Non-Employee Director Restricted Stock Plan (the “Plan”), shall be effective as of December 12, 2005.  No award shall be made under the Plan after the expiration of 10 years from August 6, 1996, the original effective date of the Plan.
 
1.2 Purpose.  The purpose of the Plan is to provide each non-employee member (“Director”) of the Board of Directors (the “Board”) of Alliant Techsystems Inc. (the “Corporation”) with awards of shares of common stock, par value $.01 per share (“Stock”), of the Corporation, subject to the restrictions and other provisions of the Plan.  It is intended that the Plan will (a) permit Directors to increase their stock ownership and proprietary interest in the Corporation and their identification with the interests of the Corporation’s stockholders (“Stockholders”), (b) provide a means of compensating Directors that will help attract qualified candidates to serve as Directors, and (c) induce incumbent Directors to continue to serve if the Board desires that they remain on the Board.
 
1.3 Shares of Stock Available Under the Plan.


 


(a) Subject to any adjustments made pursuant to Section 1.3(c), the aggregate number of shares of Stock that may be issued under the Plan shall be 168,750, taking into account the effect of the stock splits in the form of stock dividends that were paid on November 10, 2000, September 7, 2001, and June 10, 2002.
 
(b) Shares of Stock awarded under the Plan may be (i) authorized but unissued shares of Stock, (ii) previously issued shares of Stock reacquired by the Corporation, including shares purchased in the open market (collectively, “Treasury Shares”), or (iii) a combination thereof.
 
(c) Appropriate and equitable adjustment shall be made in the number of shares of Stock available under the Plan and covered by Plan awards in the event of any recapitalization, reorganization, merger, consolidation, spin-off, combination, repurchase, exchange of shares or other securities of the Corporation, stock split, reverse stock split, stock dividend, extraordinary dividend, liquidation, dissolution, or other similar corporate transaction or event affecting the Corporation.
 















 
Section 2. Restricted Stock Awards
 
2.1 Award Dates.
 
(a) As of the date of each annual meeting of Stockholders (“Annual Meeting”), commencing with the 1996 Annual Meeting and terminating December 31, 2001, each Director elected or reelected to the Board at such Annual Meeting shall be awarded 600 shares of restricted Stock (“Restricted Stock”).  Commencing January 1, 2002 and terminating March 31, 2003, as of the date of each Annual Meeting, each Director elected or reelected to the Board at such Annual Meeting shall be awarded 750 shares of Restricted Stock.  Commencing April 1, 2003, as of the date of each Annual Meeting, each Director elected or reelected to the Board at such Annual Meeting shall be awarded shares of Restricted Stock with a market value of $55,000.00 as determined by the closing market price of Stock on the date of such Annual Meeting.
 
(b) A Director who is elected to the Board on a date other than the date of an Annual Meeting shall be awarded shares of Restricted Stock as of such date of election with a market value of $55,000.00 as determined by the closing market price of the Stock on the date of such election.
 
(c) A Director may elect, in writing, on or prior to any date as of which the Director is entitled to receive a Restricted Stock award to waive the Director’s right to receive the award. Any such waiver shall apply to all future Restricted Stock awards the Director would otherwise be entitled to receive, and shall remain in effect until such time as the Director elects, in writing, to revoke such waiver. Any such revocation shall be effective with respect to Restricted Stock awards the Director is entitled to receive as of dates subsequent to the date of the revocation.
 
2.2 Issuance of Stock.  As promptly as practical after the date as of which an award is made, the Corporation shall issue a certificate (“Certificate”), registered in the name of each Director receiving an award, representing the number of shares of Restricted Stock covered by the Director’s award.
 
2.3 Rights of Holders of Restricted Stock.  Upon issuance of a Certificate, the Director in whose name the Certificate is registered shall, subject to the provisions of the Plan, have all of the rights of a Stockholder with respect to the shares of Restricted Stock represented by the Certificate, including the right to vote the shares and receive cash dividends and other cash distributions thereon.
 


2.4 Restricted Period.  Restricted Stock shall be subject to the
restrictions set forth in Sections 2.5 and 2.7 of the Plan and the other
provisions of the Plan for a period (the “Restricted Period”) commencing on the
date as of which the Restricted Stock is awarded (the “Award Date”) and ending
on the earlier of:


 


(a)                                  the third
anniversary of the Award Date with respect to an award of Restricted Stock to a
Director; or


 


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(b)                                 the first
to occur of the following:


 


	
  (i)

  	
  the retirement of the Director from the Board in
  compliance with the Board’s retirement policy as then in effect;

  



 


	
  (ii)

  	
  the termination of the Director’s service on the Board as
  a result of the Director’s not being nominated for reelection by the Board,
  but not as a result of the Director’s declining to serve again;

  



 


	
  (iii)

  	
  the termination of the Director’s service on the Board
  because the Director, although nominated for reelection by the Board, is not
  reelected by the Stockholders;

  



 


	
  (iv)

  	
  the termination of the Director’s service on the Board
  because of (A) the Director’s resignation at the request of the Nominating
  Committee of the Board, (B) the Director’s removal by action of the
  Stockholders, or (C) the sale, merger or consolidation of, or a similar
  extraordinary transaction involving, the Corporation; or

  



 


	
  (v)

  	
  the termination of the 
  Director’s service on the Board because of disability or death.

  



 


2.5 Forfeiture of
Restricted Stock.  As of the
date (“Termination Date”) a Director ceases to be a member of the Board for any
reason, the Director shall forfeit to the Corporation all Restricted Stock
awarded to the Director for which the Restricted Period has not ended as of or
prior to the Termination Date.


 
2.6 Release of Restricted Stock.  Restricted Stock shall be released to the Director, free and clear of all restrictions and other provisions of the Plan, on the first business day immediately following the last day of the Restricted Period with respect to such Restricted Stock, unless the Director has made a deferral election pursuant to Appendix A to the Plan.
 
2.7 Restrictions.  Restricted Stock shall be subject to the following restrictions during the Restricted Period:
 
(a) The Restricted Stock shall be subject to forfeiture to the Corporation as provided in Section 2.5 of the Plan.
 
(b) The Restricted Stock may not be sold, assigned, transferred, pledged, hypothecated or otherwise disposed of, and neither the right to receive Restricted Stock nor any interest under the Plan may be assigned by a Director, and any attempted assignment shall be void.
 
(c) Each Certificate representing shares of Restricted Stock shall be held by the Corporation and shall, at the option of the Corporation, bear an appropriate restrictive legend and be subject to appropriate “stop transfer” orders.  The Director shall deliver to the Corporation a stock power endorsed in blank to the Corporation.
 
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(d) Any additional Stock or other securities or property (other than cash) that may be issued with respect to Restricted Stock as a result of any stock dividend, stock split, business combination or other event, shall be subject to the restrictions and other provisions of the Plan.
 
(e) The issuance of any Restricted Stock award shall be subject to and contingent upon (i) completion of any registration or qualification of the Stock under any federal or state law or governmental rule or regulation that the Corporation, in its sole discretion, determines to be necessary or advisable; (ii) the execution by the Director and delivery to the Corporation of (A) any agreement reasonably required by the Corporation, and (B) the stock power referred to in Section 2.7(c); and (iii) the payment by the Director to the Corporation of the par value of the Restricted Stock, except to the extent that Treasury Shares are issued in connection with the award.
 
Section 3. General Provisions
 
3.1 Administration.  The Plan shall be administered by a committee (the “Committee”) that shall be the Nominating and Governance Committee of the Board or such other committee of Directors as may be designated by the Board. The Committee shall have full power, discretion and authority to interpret and administer the Plan, except that the Committee shall have no power to (a) determine the eligibility for awards of Restricted Stock or the number of shares of Restricted Stock to be awarded or the timing or value of awards of Restricted Stock to be awarded to any Director, or (b) take any action specifically delegated to the Board under the Plan. The Committee’s interpretations and actions shall, except as otherwise determined by the Board, be final, conclusive and binding upon all persons for all purposes.
 
3.2 No Retention Rights.  Neither the establishment of the Plan nor the awarding of Restricted Stock to a Director shall be considered to give the Director the right to be retained on, or nominated for reelection to, the Board, or to any benefits or awards not specifically provided for by the Plan.
 
3.3 Interests Not Transferable.  Except as to withholding of any tax required under the laws of the United States or any state or locality, no benefit payable at any time under the Plan shall be subject in any manner to alienation, sale, transfer, assignment, pledge, attachment, or other legal process, or encumbrance of any kind.  Any attempt to alienate, sell, transfer, assign, pledge, attach or otherwise encumber any such benefits whether currently or thereafter payable, shall be void.  No benefit shall, in any manner, be liable for or subject to the debts or liabilities of any person entitled to such benefits.  If any person shall attempt to, or shall alienate, sell, transfer, assign, pledge or otherwise encumber such person’s benefits under the Plan, or if by reason of such person’s bankruptcy or any other event, such benefits would devolve upon any other person or would not be enjoyed by the person entitled thereto under the Plan, then the Committee, in its discretion, may terminate the interest in any such benefits of the person entitled thereto under the Plan and hold or apply them to or for the benefit of such person entitled thereto under the Plan or such person’s spouse, children or other dependents, or any of them, in such manner as the Committee may deem proper.
 
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3.4 Amendment and Termination.  The Board may at any time amend or terminate the Plan; provided that:
 
(a) no amendment or termination shall, without the written consent of a Director, adversely affect the Director’s rights under outstanding awards of Restricted Stock; and
 
(b) Stockholder approval of any amendment shall be required if Stockholder approval is required under applicable law or the listing requirements of any national securities exchange on which are listed any of the Corporation’s equity securities.
 


3.5 Severability.  If all or any part of the Plan is declared by
any court or governmental authority to be unlawful or invalid, such
unlawfulness or invalidity shall not serve to invalidate any portion of the
Plan not declared to be unlawful or invalid. 
Any Section or part thereof so declared to be unlawful or invalid shall,
if possible, be construed in a manner which will give effect to the terms of such
Section or part thereof to the fullest extent possible while remaining lawful
and valid.


 


3.6 Controlling Law.  The law of Delaware, except its law with respect to choice of law, shall be controlling in all matters relating to the Plan.
 
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Exhibit 10.1
 


APPENDIX A

TO ALLIANT TECHSYSTEMS INC.

AMENDED AND RESTATED NON-EMPLOYEE DIRECTOR

RESTRICTED STOCK PLAN


 


RESTRICTED STOCK DEFERRALS


 


Section 1.                                            Purpose and Effect.


 


(a)                                  This
Appendix A to the Alliant Techsystems Inc. Amended and Restated Non-Employee
Director Restricted Stock Plan (the “Plan”) authorizes the deferral of income
that would otherwise be recognized upon the lapse of restrictions applicable to
Restricted Stock awards under the Plan.


 


(b)                                 In
accordance with the rules set forth in this Appendix A, Directors may elect to
forfeit shares of Restricted Stock that would otherwise vest pursuant to the
terms of the Plan and the relevant Restricted Stock award in exchange for the
Corporation’s agreement to pay deferred compensation in the form of
unrestricted shares of Stock (“Restricted Stock Deferral”).  The Restricted Stock awards that may be
subject to deferral elections authorized by this Appendix A are limited solely
to those made under the Plan.


 


(c)                                  No
Restricted Stock or other shares of Stock are authorized to be issued under
this Appendix A other than pursuant to Section 5(c) of this Appendix A.  Grants and vesting of Restricted Stock awards
are governed by the Plan, as it may be amended from time to time.


 


Section 2.                                            Definitions. 
For purposes of this Appendix A, the terms defined in the Plan shall
have the same meanings when used in this Appendix A.  In addition, the terms listed below shall
have the following meanings:


 


(a)                                  Deferred
Stock Unit Account shall mean the account
established for each Director in accordance with Section 5 of this Appendix A.


 


(b)                                 Stock Unit shall mean each one of the units credited to a Director’s Deferred Stock
Unit Account based on the number of shares of Restricted Stock forfeited
pursuant to Section 4 of this Appendix A or shares of Stock credited to the
Deferred Stock Unit Account pursuant to Section 5(c) of this Appendix A.


 


Section 3.                                            Eligibility. 
A person shall be eligible to make deferrals pursuant to this Appendix A
if he or she is a non-employee member of the Board of Directors of the
Corporation who participates in the Plan. 
A person who ceases to be a non-employee member of the Board of the
Corporation shall not be eligible to make deferrals pursuant to this Appendix
A.


 


Section 4.                                            Restricted Stock Deferral.


 


(a)                                  For
Restricted Stock with respect to which the Restricted Period would otherwise
end pursuant to Section 2.4 of the Plan (the “Vesting Date”) before January 1,
2005, at least 12


 





















 


complete months prior to the Vesting Date a Director may elect,
in accordance with the procedures set forth in this Section 4 and elsewhere in
this Appendix A, to forfeit all of such shares of Restricted Stock and be
credited instead in the Director’s Deferred Stock Unit Account with a number of
Stock Units equal to the number of shares of Restricted Stock forfeited
pursuant to the deferral election. For Restricted Stock with respect to which
the Vesting Date would otherwise occur between January 1, 2005 and December 31,
2008, a Director may make such a deferral election on or before March 15, 2005.
For Restricted Stock with respect to which the Vesting Date would otherwise
occur in 2009, a Director may make such a deferral election on or before
December 31, 2005. If a Director is initially elected as a Director prior to
the 2006 annual meeting of stockholders, the Director may make a deferral
election within 30 days after the date of being elected to the Board with
respect to the number of shares of Restricted Stock that would otherwise be
granted as of the date of the 2006 annual meeting of stockholders.


 


(b)                                 A deferral
election made pursuant to this Section 4 shall be timely made in writing in
accordance with Section 7 of this Appendix A and shall specify the time of
payment in accordance with the rules for payment under Section 6 of this
Appendix A.  Any deferral election made
pursuant to this Section 4 shall be irrevocable and shall apply to 100%, but
not less than 100%, of the shares of Restricted Stock with respect to which the
Restricted Period would otherwise end on the Vesting Date.


 


(c)                                  For an
election to defer Restricted Stock to be valid the deferral election form must
(i) be received by the Corporation (to the attention of the Corporate
Secretary) by the time prescribed in subsection (a) and (ii) provide for the
forfeiture of the Restricted Stock which is the subject of the deferral
election and, if applicable, the transfer to and reacquisition by the
Corporation of such Restricted Stock as of the date of receipt by the
Corporation of the election to defer.


 


Section 5.                                            Deferred Stock Unit Account.  A Deferred Stock Unit Account shall be
established and maintained on behalf of each Director for Restricted Stock
deferred pursuant to this Appendix A, subject to the following rules:


 


(a)                                  For each
share of Restricted Stock deferred, a Stock Unit shall be credited to the
Director’s Deferred Stock Unit Account as of the Vesting Date of the Restricted
Stock subject to the deferral election.


 


(b)                                 On each
payment date for any cash dividends paid on the Corporation’s Stock, the
Corporation shall pay to each Director an amount equal to the cash dividends
that would be payable by the Corporation on a number of shares of Stock equal
to the number of Stock Units in the Director’s Deferred Stock Unit Account as
of such payment date.  Such amounts shall
be paid directly to each Director in cash and shall not be eligible for
deferral under this Plan.


 


(c)                                  The number
of units credited to the Director’s Deferred Stock Unit Account shall be
appropriately and equitably adjusted to reflect any change in the outstanding
Stock of the Corporation in the event of any recapitalization, reorganization,
merger, consolidation, spin-off, combination, repurchase, exchange of shares or
other securities of the Corporation, stock split, reverse stock split, stock
dividend, extraordinary dividend, liquidation, dissolution, or other similar
corporate transaction or event affecting the Corporation.


 


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(d)                                 Directors
who elect to make a deferral of Restricted Stock in accordance with this
Appendix A will have no rights as Stockholders of the Corporation with respect
to Stock Units credited to their Deferred Stock Unit Accounts.


 


Section 6.                                            Payment of Deferred Amounts.


 


(a)                                  Payment of
the aggregate value of 100% of the Stock Units in the Director’s Deferred Stock
Unit Account shall be made in a lump sum at the time specified by the Director
in his or her deferral election (the “Payment Date”).  Notwithstanding the foregoing, in all events
payment of a Director’s entire Deferred Stock Unit Account shall be made in a
lump sum as soon as administratively feasible following the occurrence of the
earliest of the following events:


 


(i)                                     the retirement of the Director from the Board in compliance with the Board’s
retirement policy as then in effect;


 


(ii)                                  the termination of the Director’s service on the Board as a result of the
Director’s not being nominated for reelection by the Board, but not as a result
of the Director’s declining to serve again;


 


(iii)                               the termination of the Director’s service on the Board because the
Director, although nominated for reelection by the Board, is not reelected by
the Stockholders;


 


(iv)                              the termination of the Director’s service on the Board because of (A) the
Director’s resignation at the request of the Nominating Committee of the Board,
(B) the Director’s removal by action of the Stockholders, or (C) the sale,
merger or consolidation of, or a similar extraordinary transaction involving,
the Corporation; or


 


(v)                                 the termination of the  Director’s
service on the Board because of disability or death.


 


The date
of retirement or termination of service of a Director pursuant to any of the
events described in subsections (i) through (v) above shall constitute the
Payment Date for purposes of this Appendix A.


 


(b)                                 Payment of
the aggregate value of the Stock Units in a Director’s Deferred Stock Unit
Account shall be made solely in the form of shares of Stock.  On the Payment Date the Corporation shall pay
to the Director a number of shares of Stock equal to the number of Stock Units
in the Director’s Deferred Stock Unit Account on such Payment Date.


 


(c)                                  A Director
shall submit to the Corporation a written designation of the beneficiary or
beneficiaries to whom payment of the aggregate value of the Director’s Deferred
Stock Unit Account shall be made in the event of the Director’s death.  Beneficiary designations shall become
effective only when received by the Corporation.  If a Director has not designated a
beneficiary, or if no beneficiary is living on the Payment Date, the Director’s
vested account shall be distributed to the representative of the Director’s
estate.  Payment to the Director’s


 


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designated
beneficiary shall be made in the form of Stock in accordance with the
provisions of Sections 6(a) and 6(b) of this Appendix.


 


Section 7.                                            Forms and Procedure.  Deferral elections and beneficiary
designations made pursuant to this Appendix A must be made in writing on forms
substantially similar to the forms set forth in Exhibit I to this Appendix A,
and shall be subject to such other procedural rules as the Committee may
establish.


 


Section 8.                                            Effect on Restricted Stock Awards.  Deferral elections made pursuant to this
Appendix A shall constitute amendments to the Restricted Stock awards to which
the deferral elections apply, but only to the extent such Restricted Stock
awards are expressly modified by this Appendix A.  Any shares of Stock paid to a Director
pursuant to this Appendix A with respect to a Director’s deferral election
shall be issued under the Plan with respect to the corresponding Restricted
Stock award.


 


Section 9.                                            Unfunded and Unsecured Plan.  The Director’s Deferred Stock Unit Account
shall be hypothetical in nature and shall be maintained for bookkeeping
purposes only.  The Deferred Stock Unit
Account shall be unfunded for tax purposes and no provision shall be made at
any time with respect to segregating assets of the Corporation for payment of
amounts in the Deferred Stock Unit Account. 
The obligation of the Corporation to make payments pursuant to this
Appendix A constitutes an unsecured but legally enforceable promise of the
Corporation to make such payments.


 


Section
10.  Effective Date.  This Appendix A shall be effective as of the
date adopted by the Board of Directors of the Corporation and the deferral
election provided herein shall be available only with respect to awards of
Restricted Stock made pursuant to the Plan on or after the effective date
hereof. This Appendix A is amended and restated effective as of January 1, 2005
to comply with section 409A of the Internal Revenue Code of 1986, as amended.


 


Section
11. Construction. Any deferral election that is inconsistent with Code
section 409A with respect to Restricted Stock for which the Vesting Date is
after December 31, 2004 shall not be effective.


 


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EXHIBIT I TO APPENDIX A

NON-EMPLOYEE DIRECTOR RESTRICTED STOCK

DEFERRAL ELECTION FORM

AND DESIGNATION OF BENEFICIARY FORM


 


ALLIANT TECHSYSTEMS INC.


AMENDED AND RESTATED NON-EMPLOYEE
DIRECTOR


RESTRICTED STOCK PLAN


Amended and Restated as of December
12, 2005


 


ELECTION TO DEFER


 


 


	
  TO:

  	
  Alliant Techsystems Inc.

  
	
   

  	
  Attn: Assistant Secretary

  



 


 


Pursuant to the terms and conditions of the Alliant
Techsystems Inc. Amended and Restated Non-Employee Director Restricted Stock
Plan, Amended and Restated as of December 12, 2005 (the “Plan”), I hereby make
the following election to defer with respect to Restricted Stock to be awarded
to me pursuant to the Plan.


 


All capitalized terms not expressly defined in this election
to defer have the meanings set forth in the Plan.


 


1.                      Deferral of Restricted Shares: I hereby irrevocably:


(a) elect to
defer 100% of my Restricted Stock award described below that, in accordance
with the provisions of the Plan, will be awarded on the date set forth below;
and


 


(b) agree that
such Restricted Stock award shall be waived.


 


Please complete:


 


Number of
Shares                                  


 


Award Date of Shares:  August


 


Vesting
Date:  August


 


As set forth in Section 4(a) of Appendix A to the Plan,  “Vesting Date” means the date on which the
Restricted Period ends with respect to that Restricted Stock pursuant to
Section 2.4 of the Plan.


 


 


2.                       Time of Payment:                                                     I hereby irrevocably elect to have my Deferred Stock Unit Account paid out
at the following time:


 





















 


                                                        


 


	
   

  	
  as soon as administratively practicable after I cease to be
  a Director of the Corporation; or

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  at such other time as here specified

  	
   

  	
   

  



(not later than the Plan provides).


 


I understand that all payments of my Deferred Stock Unit
Account will be made in the form of Stock of the Corporation in accordance with
the terms of the Plan.


 


This election to defer is made as of
the date of my signature below.  I
understand and acknowledge that to be effective this election to defer form
must be fully and properly completed and received by the Corporation in
accordance with the terms of the Plan.


 


I understand that the foregoing
elections are irrevocable and will apply to all of the Restricted Stock
described above.  This election to defer
constitutes an amendment to the Restricted Stock award to which this election
applies, but only to the extent that the award of Restricted Stock is expressly
modified by the election.


 


I certify that the foregoing
elections are not being made in reliance upon any financial or tax advice given
by the Corporation.  I understand that I
should consult my own tax advisor as to the tax consequences of my elections.


 


	
  Date:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  (Signature
  of Non-Employee Director)

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name:

  



 


 


 


Received by the
Corporation:


 


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Alliant
Techsystems Inc.


 


	
  Date: 

  	
   

  	
   

  



 


	
  Acknowledged:

  	
   

  
	
   

  	
  Name and Title

  
	
   

  	
  Office of Corporate Secretary

  



 


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AMENDED AND RESTATED NON-EMPLOYEE
DIRECTOR


RESTRICTED STOCK PLAN


Amended and Restated as of December
12, 2005


 


DESIGNATION OF BENEFICIARY


(Please type or print)


 


	
  Name of Director

  	
   

  	
  Marital Status: Single 

  	
   

  
	
  Social Security No.

  	
   

  	
  Married 

  	
   

  
					



 


I hereby revoke any previous designation(s) of beneficiary
made by me with respect to amounts payable by Alliant Techsystems Inc. (the “Corporation”)
under the Corporation’s Non-Employee Director Restricted Stock Plan in the
event of my death; and I hereby designate the following person(s) or entity to
receive, upon my death, any such amounts:


 


 


Primary Beneficiary or Beneficiaries:


 


	
  Name:

  	
   

  	
  Share:

  	
   

  	
  %

  	
  Relationship:

  	
   

  	
  Birth Date:

  	
   

  
	
  Address:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  SS #

  	
   

  
	
  Name:

  	
   

  	
  Share:

  	
   

  	
  %

  	
  Relationship:

  	
   

  	
  Birth Date:

  	
   

  
	
  Address:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  SS #

  	
   

  
											



 


Contingent Beneficiary or Beneficiaries (if your Primary Beneficiary(ies) all predecease you):


 


	
  Name:

  	
   

  	
  Share:

  	
   

  	
  %

  	
  Relationship:

  	
   

  	
  Birth Date:

  	
   

  
	
  Address:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  SS #

  	
   

  
	
  Name:

  	
   

  	
  Share:

  	
   

  	
  %

  	
  Relationship:

  	
   

  	
  Birth Date:

  	
   

  
	
  Address:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  SS #

  	
   

  
											



 


	
  Date:

  	
   

  	
   

  	
  Director’s
  Signature: