Form Gfd - General Fund Donation Voucher

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Form GFD
Virginia Department of Taxation
General Fund Donation Voucher
these donations are also allowable as itemized
The Virginia General Assembly, in the 2002
deductions under IRC §170. Taxpayers making
session, passed legislation providing that a
donations pursuant to this section may (i) include
taxpayer wanting to donate money in excess of
their donations when filing their Virginia income
his tax liability to the Commonwealth may do so
tax return, or (ii) deliver such donations, either in
at any time by writing a check payable to the State
person or by mail, to the Tax Commissioner. " Va.
Treasurer and designating it as a donation to the
Code §58.1-17.
Commonwealth’s general fund. Such donations
will be used only for public purposes. Currently,
Fill in the amount of your General Fund
Sign and date where indicated. If both spouses'
donation in the boxes below to the right.
names are given then both spouses must sign
and date the voucher.
Fill in all requested information in the SSN,
name and address boxes. If this is a joint
Please give a daytime phone number in case
donation, please enter spouse's SSN and
we need to contact you about your donation.
name.
Check one box at the bottom of the page to
Date Donation Sent
show whether or not you want your name(s)
listed on the Department of Taxation web site
Check Or Money Order Number
as a General Fund Donor. Make a note of your
selection below for your records.
Donation Amount $
Put names on Web-site,
gov. I(we) understand that no other identifying
information, including donation amounts, addresses
or social security numbers will be made public.
Do not publish my(our) name(s) on Web-site.
Cut on the dashed line below; save the top section for your records; mail the voucher below to the address on the voucher.
office use only
Make Check or Money Order Payable to:
Please do not staple
State Treasurer
FORM GFD General Fund Donation Voucher
Virginia Department Of Taxation
P.O. Box 2468, Richmond, VA 23218-2468
For Information Call 804-367-8031
Donation Amount
.
00000000
0000000 000000
Your SSN Or VA Account #
Your First Name (Or Business' Name)
MI
Last Name
Suffix
Spouse’s SSN
Spouse’s First Name
MI
Last Name
Suffix
Address (Number And Street)
City
State
Zip Code
Please publish my(our) name(s) on the list of donors posted on the Department of Taxation Web-site: gov. I(we) understand
that no other identifying information, including donation amounts, addresses or social security numbers will be made public.
Please do not publish my(our) name(s) on the list of donors.
Your Signature
Date
Spouse's Signature
Date
Daytime Telephone Number
Va. Dept. Of Taxation Form GFD W Rev. 1/12

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