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State of Wisconsin
Closure Irrevocable Trust Agreement
Department of Natural Resources
(For Use by Solid Waste Landfills)
Form 4400-068
Rev. 8/08
LEAVE BLANK – DNR USE ONLY
License Number
FID Number
In order to provide proof of financial responsibility in accordance with section 289.41, Wisconsin Statutes, and
section NR 520.05, Wisconsin Administrative Code, as amended, to ensure that the closure requirements of the plan of
operation approval for the __________________________________________________ Solid Waste Landfill issued by the
State of Wisconsin Department of Natural Resources (hereafter, DNR), to_________________________________________
(Owner)
_____________________ of ___________________________________________________________________________,
(Address)
dated the ________________ day of _________________, __________, and any amendments hereto, will be complied with,
_______________________________________________________________ as Settlor, hereby enters into this irrevocable
(Owner)
trust agreement and hereby transfers to ____________________________________________________________________
(Bank or Financial Institution)
of _________________________________________________________________________________, a bank or financial
(Address)
institution located in the State of Wisconsin which has the authority to act as a trustee and whose trust operations are
regulated and examined by a state or federal agency, as Trustee, the cash, certificates of deposit, or U.S. government
securities described on Schedule "A" attached hereto, having a current market value of ______________________________
____________________________________________________________________ Dollars ($______________________)
in trust for the DNR as sole beneficiary to be held subject to the terms and conditions set forth below. This trust is created
this ______________ day of _________________, ________, and shall continue until terminated as hereafter set forth. The
(Date)
trust shall be named the "Closure Trust for the ______________________________________________________________
(Solid Waste Land Disposal Facility)
Solid Waste Landfill" located in Section ________, Township ________, Range __________, Town/City/Village of
___________________________________, ______________________________ County, Wisconsin.
1.
A total of no more than $100,000.00 in cash or certificates of deposit may be deposited into the trust fund and any
other account established by the Owner in the same bank or financial institution for the purpose of providing proof of
financial responsibility to the DNR. U.S. government securities shall be used for amounts in such accounts in excess
of $100,000.00.
2.
All interest, and other trust fund earnings and profits, shall be accumulated in the trust fund. There shall be no
withdrawals from the trust fund except as authorized in writing by the Secretary of the DNR.