In-Kind Donation Form - The Family Tree Information, Education & Counseling Center
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1THE FAMILY TREE
INFORMATION, EDUCATION & COUNSELING CENTER
In-Kind Donation Form
Name:
Prefix (Dr./Mrs./Mr./Ms.)
First
Middle
Last
Mailing Address:
City:
State:
Zip:
Preferred Phone:
Cell
Home
Email Address:
Donation Description:
Donor Estimated Value (Optional)
$
Donor Signature:
If the donor estimated value is more than $500, the IRS requires a qualified, certified appraisal of the donation which
must be attached to this form.
Certified Appraisal Attached?
Yes
No
I would like my gift to remain anonymous
Please complete this section if your donation is in honor or memory of someone.
In Honor
OR
In Memory of
Send Acknowledgement to:
Name:
Prefix (Dr./Mrs./Mr./Ms.)
First
Middle
Last
Mailing Address:
City:
State:
Zip:
Thank you for your support!
To be completed by The Family Tree Staff:
Staff Signature
Date Received
P. O. Box 62904, Lafayette, LA 70596 • Tel: 337-981-2180 • Fax: 337-261-1911 •
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