Donation Form (Page 2 of 2) in pdf

Donation Form Page 2

FOR MEMORIAL GIFTS AND HONORARIUMS, SEND NOTIFICATION TO:

First Name: ________________________________________

Last Name: ________________________________________

Address1: _________________________________________

Address2: _________________________________________

City: _____________________________________

State: _________________

Zip: __________________

Recipient’s Relationship to deceased:________________________________________

Additional Donor Names: __________________________________________________

______________________________________________________________________

Recognition of gift: All contributions to Hospice are tax deductible to the extent allowed by law. A thank

you/receipt letter will be sent to donors. Notification will be sent to other individuals as requested (the

amount will not be specified).

If you have questions regarding a memorial or honorarium donation, please contact the Our Hospice

Resource Development Office at 812.314.8097 or 1.800.841.4938 Ext. 8097, or by email at

for assistance.

Donation Form Page 2