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: Address: City/Town: State/Province: - None - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming 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. File Upload One file only.64 MB limit.Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods. I/We want to support the mission of Senior Friendship Centers through a planned gift as described below: I/We have included a bequest for Senior Friendship Centers in my/our will or living trust. I/We have named Senior Friendship Centers as a beneficiary of an asset: Retirement Plan Bank, Investment, or Other Financial Account Life Insurance Policy Other: Enter other… I/We have named Senior Friendship Centers as a revocable beneficiary of a charitable remainder trust. I/We have named Senior Friendship Centers 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 (Please note the amount of your intended gift will not be published): No, please do not include me/us in listings. Signature: Sign above Leave this field blank
