Confidential Intention Form

Information submitted through this webform is not legally binding.

Personal Information

Name:

First Name:

Last Name:

Spouse Name:

Spouse First Name:

Spouse Last Name:

Address:

City/Town:

State/Province:

ZIP/Postal Code:

Phone:

Email:

Date of Birth:

Your Gift Intention

Please provide the following information and attach a copy of the documentation or appropriate language from your will or trust, if available. Please complete all that apply.

I/We want to support the mission of [charity_name] through a planned gift as described below:

I/We have included a bequest for [charity_nickname] in my/our will or living trust.

I/We have named [charity_nickname] as a beneficiary of an asset:

Retirement Plan

Bank, Investment, or Other Financial Account

Life Insurance Policy

Other:

Enter other…

I/We have named [charity_nickname] as a revocable beneficiary of a charitable remainder trust.

I/We have named [charity_nickname] as an irrevocable beneficiary of a charitable remainder trust.

Approximate anticipated value of gift:

Please provide a general description of the gift provision (such as, asset to be donated if other than cash or securities, how gift is to be used, whether gift is to create an endowment, etc.):

Yes, you may include me/us in listings of planned gift donors.

Please indicate how you would like your name(s) to appear in our [legacy_society] listings. (Please note the amount of your intended gift will not be published):

No, please do not include me/us in listings.

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