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Information Request Form
There
is no obligation on your part in requesting information or a personal analysis
of your financial circumstances. Any information provided by you will be maintained
in the strictest of confidences and any response by us is for your informational
purposes only.
If you would prefer to mail or fax this information
to us, please use the print function.
Cash Gift
Appreciated Securities
Bequests
Real Estate
Gifts of Life Insurance
Gifts of Retirement Assets
Charitable Remainder Trusts
Charitable Gift Annuities
Bargain Sales
Retained Life Estate (definition)
Charitable Lead Trusts
Are you considering a gift
currently?
Yes
No
Uncertain
Would
you like to inform us of a bequest or other gift?
Yes,
I have made a bequest or other planned gift and would be pleased to have my name
included as a donor.
Yes, I have made a bequest or other planned gift but right now I would
prefer to remain anonymous.
Additional
Comments or Requests
Add to
Mailing
List
Yes - please mail to above postal address.
Yes - please e-mail me as above.
No thank you.
With the following information, we will provide you with a calculation
of your benefits using a Charitable Gift Annuity. There are other gift
options that might be better suited for your individual financial circumstances
which we will be glad to discuss with you. This is entirely confidential
and the information you provide will be held in the strictest confidence.
Age:
If this annuity is to last for
the lifetime of another person in addition to yourself, please enter that other
person's age:
The dollar
amount of the annuity you wish to establish:
If you wish to fund the annuity with appreciated assets, such as stocks,
please indicate the original cost or basis of the assets (please disregard if
the funding is to be with cash):
Our calculation will make assumptions as to the payout rate and the actual
date of the gift. These assumptions are simply to give you a general idea of the
income and tax benefits such a gift will provide you. There are other variables
that may affect the actual benefits. This calculation is just a general idea of
the benefits based on the current information and market conditions available
at this time.
If you wish, you may set up the annuity now but defer the
income to a future date. If so, please indicate the age (both ages if for two
persons) at which you would like to start receiving annuity payments.
Your
age at payment start:
Second
person's start age:
Please type the code shown in the image (it is case
sensitive):
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Please note, individual financial circumstances will vary. The information on this site does not constitute legal or tax advice. Donor stories and photographs are for purposes of illustration only. As with all tax and estate planning, please consult your attorney or estate specialist. All material is copyrighted and is for viewing purposes only. Use of this site signifies your agreement with the terms of use. The content in this Planned Giving section has been developed for the Foundation of Mon General Hospital by Future Focus. Please report any problems to section webmaster.
