Planned Gift Notification

Name

Date of Birth

Address

City

State

Zip

Phone

Email

Will Living Trust Retirement Plan Life Insurance Policy Charitable Remainder Trust Other

% of my/our will, currently valued at $ for the MCHF.

% of my/our living trust, currently valued at $ for the MCHF.

% of my/our retirement plan, currently valued at $ for the MCHF.

% of my life insurance policy, currently valued at $ for the MCHF.

% of my/our charitable remainder trust, currently valued at $ for the MCHF.

OTHER: % of my/our , currently valued at $ for the MCHF.

Recognition: Please list us as members of the 1775 Society as follows:

I/We wish for this planned gift to be anonymous.

Planned Gift Details:

Signature:

Date:

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