Schedule B (Form 990, 990-Ez, Or 990-Pf) - Schedule Of Contributors - 2012 Page 4

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Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page
Name of organization
Employer identification number
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.)
$
▶
Use duplicate copies of Part III if additional space is needed.
(a) No.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
from
Part I
(e) Transfer of gift
Transferee’s name, address, and ZIP + 4
Relationship of transferor to transferee
(a) No.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
from
Part I
(e) Transfer of gift
Transferee’s name, address, and ZIP + 4
Relationship of transferor to transferee
(a) No.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
from
Part I
(e) Transfer of gift
Transferee’s name, address, and ZIP + 4
Relationship of transferor to transferee
(a) No.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
from
Part I
(e) Transfer of gift
Transferee’s name, address, and ZIP + 4
Relationship of transferor to transferee
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

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