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    Planned Giving

Estate Intention Form

This is a confidential record. In order that we may include you in our planned giving society, value your future gift for any campaign purposes and properly thank you and acknowledge your gift, please fill out the following information which applies to your future gift of a bequest through your Will or Trust.

If you would prefer to fax or mail this information to us, please use our printable form.

I look forward to talking with you about this gift intention. I understand that listing this gift may be an incentive for others to give and I am willing to be publicly acknowledged.

I understand you would like to contact me and I would be happy to discuss this with you but I prefer not to be listed or acknowledged publicly.

My Will/Trust was signed on:

My Will/Trust provides that % shall be bequeathed to Self Regional Healthcare Foundation through my estate. As of today's date, I estimate that the value of this provision in my estate plan would be approximately $ .

My Will/Trust provides that $ shall be bequeathed to Self Regional Healthcare Foundation through my estate.

My Will/Trust provides that certain items of real or personal property shall be bequeathed to Self Regional Healthcare Foundation through my estate. The items are as follows:

As of today's date, I estimate these items to be worth approximately $ .

My Will/Trust indicates that the bequest through my estate is unrestricted.
My Will/Trust directs Self Regional Healthcare Foundation to use my bequest through my estate for a specific purpose.

The specific purpose is as follows:

I understand that I am not making a legal, or binding, commitment upon my estate by submitting this Estate Intention Form. Further, Self Regional Healthcare should understand that the size of my future gift might be significantly different from the amount estimated above for the purposes of valuation in any campaign. If for any reason in the future Self Regional Healthcare is no longer included in my estate plan, I will notify you so that you can update your records and remove me from the planned giving society.

Donor:
Phone Number:
Date:

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 Self Regional Healthcare by Future Focus. Please report any problems to webmaster. Revised: July 10, 2008 15:53 .