OFFICIAL FORM FOR RELEASE OF RECORDS PRINCESS

OFFICIAL FORM
FOR
RELEASE OF RECORDS
PRINCESS RECORDER AND PRINCESS BANKER
(READ ALL INSTRUCTIONS ON REVERSE SIDE BEFORE FILLING OUT THIS FORM)
DO NOT MAIL TO THE SUPREME RECORDER
I, _________________________________as the duly elected _______________________of
Recorder/Banker
______________________Temple No. ______, Daughters of the Nile, hereby agree to the following:
1. In the event of my death, incapacity, and/or inability to fulfill my duties as the duly elected Recorder/Banker,
thereby authorize and direct the authorized representative(s) of _________________Temple No. ______, to
immediately obtain and retrieve from my premises and/or estate any and all records, equipment, materials and
documents relating to my said position as Recorder/Banker of ______________________Temple No. ______.
At the time of occurrence of such event, the representative(s) of ______________________Temple
No.______ shall immediately contact the personal representative of my said estate, or the attorney therefore,
requesting the release of such records, equipment, materials, and documents, relating to my said position.
Such items shall include, but are not limited to the following:
(Insert the inventory by attachment to this Agreement of typed listing.)
My personal representative(s) and/or attorney to contact for release of attached inventory list is:
Name: ________________________________________Phone: ____________________________
Address: _________________________________________________________________________
The above referenced duly authorized representative(s) of ______________________Temple No.______
shall include Queen, Royal, Tirzah, Badoura, or Junior Past Queen, and such shall be the only parties
authorized to remove such items from my premises and/or estate.
The removal of the above referenced records, equipment, materials and documents relating to my position
shall be done immediately upon my death, incapacity (as determined by a qualified, licensed physician)
and/or inability to act in my designated position (as determined by a majority vote of the members of
______________________Temple No.______.)
The retrieval and removal of such items in question shall be coordinated and carried out between the
authorized representative(s) of ______________________Temple No.______ and the individual, entity or
representative of my person and/or estate.
2. In the event of my resignation from my position as Recorder/Banker, I also hereby agree, authorize and
direct that I shall immediately relinquish and provide to the authorized representative(s) of
______________________Temple No.______ any and all records, equipment, materials and documents
relating to my said position, including but not limited to the items and materials contained in the attached
inventory list.
3. I further understand and agree that the retrieval of any and all records, equipment, and materials and
documents by ____________________Temple No.______ or the authorized representative(s) thereof, relating
to my said position with ____________________Temple No.______ is imperative and time is of the essence.
Thus, I or the representative of my person and/or estate, must, and will, provide such, in a reasonable and
timely manner, to the authorized representative(s) of _____________________Temple No.______ in order to
avoid, and not create, a hardship upon the operation of _____________________Temple No.______.
On this date, I hereby agree to the above terms and conditions:
Signed this ______day of ________________, 20____
Recorder/Banker of ______________________Temple No. _______
Signature________________________________________________
Name Printed_____________________________________________
INSTRUCTIONS
Each subordinate Temple shall receive two Release of Records forms. The appropriate officer shall enter her title in
the first line and circle her position title in the agreement segment---third line from the bottom. Place the original of
each Officers form in a file entitled “OFFICIAL RELEASE OF RECORDS” to be kept in the Princess Recorder’s Office.
Give a currently signed copy of each form to the Reigning Queen and the Princess Recorder and Princess Banker
respectively. The Princess Recorder and Princess Banker shall be encouraged to give a copy to their personal
representative(s) and/or attorney. The ORIGINAL currently signed copy shall be available for inspection by the
Supreme Queen. DO NOT MAIL/RETURN THIS FORM TO THE SUPREME RECORDER.
SUBMISSIONS
Users recognize that they are responsible for whatever information they present, and have full responsibility for the
information in each statement, including its legality, reliability, appropriateness, and good faith. The Supreme Temple
shall fully cooperate with any law authorities or court order seeking or directing the removal of all properties associated
to these two Subordinate Temple positions.
INDEMNIFICATION
The Temple officer’s legal representative shall indemnify and be responsible for all claims, liabilities, damages, and
expenses arising from any breach of these terms on behalf of the stated Officer. The officer’s descendants, if this
document is altered in any manner, shall not consider it being a legal document; the language and/or format shall
remain as stated is essential for the protection of all parties involved.