Donation Form Kansas State University Page 2
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3KSUF-2 Gift-In-Kind Form
Print Form
Date
DONOR INFORMATION
Donor ID # (if available)
Name
Address
City
State
Zip Code
GIFT DESCRIPTION
Provide Donor intended use, Equipment brand, Model #, Serial # and Condition of property. Attach Documentation
Men's:
Women's
___Slacks _______
__Shoes_______
__Slacks_______
__Sweaters_____
__Shoes_____
___Shirts _______
__Belts________
__Blouses______
__Jackets______
__ Belts______
___Ties ________
__Suit Coats____
__Suits ________
__Scarves______
___Vests_______
__Suits_______
__Dresses_______
__Coats________
GIFT VALUATION
Donor's Valuation of Gift:
BASIS FOR VALUATION OF GIFT
Sales Quotation or Invoice
Market Price
Outside Appraisal
Other (please describe)
NOTES TO DONOR(S):
KSU Foundation gratefully acknowledges your in-kind contribution. The following information is being provided for your convenience and does not constitute legal advice
on behalf of the KSU Foundation or its employees.
You are strongly encouraged to consult with your tax advisor:
* To claim a tax deduction for in-kind gifts valued between $500 and $5,000, the donor must complete Part I of IRS Form 8283 and attach it to their tax return
* For gifts that exceed $5,000, the donor must:
** Complete ALL parts of IRS Form 8283 and submit the complete form to KSU Foundation for a signature.
** Submit a certified appraisal dated no more than 60 days from the date of the donation. The appraisal must be prepared, signed and dated by a
qualified, third-party appraiser.
The value of any item, regardless of the amount, is used for internal gift reporting only--the KSU Foundation does not include the estimated value on a donor receipt or
acknowledgement. It is the responsibility of the donor to substantiate the fair market value for his/her own tax purposes.
My signature below verifies that I donated the property listed above to the Kansas State University Foundation. In doing so, I hereby
relinquish all claims to ownership of said property.
Donor's Signature
Date of Gift:
UNIVERSITY OFFICE
C19400
Career & Employment Services
Fund #
Fund Name
Sharon Fritzson
CES
532-1691
Person completing form
Department:
Campus Phone
Location of property recvd
Exempt use of property
Holtz Hall
Signature-Department Head
Date
Signature-Dean
Date
Kerri Day Keller, Director
Print Name-Dean
Print Name-Department Head
KSU Foundation Use Only
Donor #____________________ Gift Date____________________ Fund # ____________________ Campaign Code _________________
Account # _____4004/3105 Artwork (A)
_____4007/3108 Furnishings (G)
_____4001/3113 Rental Service (M)
_____4012/3109 Books & Pub (B)
_____4002/3112 Auto, Boat, Plane (J)
_____4201/3109 Construction (N)
_____4005/3106 Computer (D)
_____4009/3110 Prof Services (K)
_____4025/3109 Other (O)
_____4006/3107 Equipment (E)
_____4003/3111 Livestock (L)
Approved by ______________________________________
Date approved_____________________
KSU Foundation (REV 12/2010)
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