Author: Dena Kaufman

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Legacy Gift Confirmation

To benefit future generations, I/we declare this commitment to assure the continuity of Jewish services and programs in (Community) and I/we affirm that I/we have made the following legal arrangements for my/our gift.

Name: ______________________________________________ City: _________________ State: ____
Email: _______________________________________ Phone: ________________________________

I/We intend for the following organization(s) to benefit from my/our Legacy gift:
Please show the percentage or amount of your gift to each organization:

_______ Organization ________ Organization
_______ Organization ________ Organization
_______ Organization ________ Organization
_______ Organization ________ Organization
_______ Organization ________ Organization
_______ Organization ________ Other: ________________________________

Optional Section My/Our commitment is within the following document: (please list amount or percentage)

_______ Gift in Will or Trust (can be percentage, residual, or specific amount)
_______ Beneficiary of Retirement Plan, Administered by: ______________________________________
_______ Beneficiary of Life Insurance Policy, Insurance Company: _________________________________
_______ Cash Endowment Gift
_______ Gift that provides lifetime income (Charitable Gift Annuity or Charitable Remainder Trust)
_______ Gift that provides income to heirs (Charitable Gift Annuity or Charitable Lead or Remainder Trust)
_______ Real estate, Personal property, Securities, Specialty asset, Business Interest
_______ Other: ________________________________________

Attorney, Financial Advisor, Family member, Executor, or Trustee for my/our gift is:
Name: _______________________________________ Phone or Email: _________________________

Donor Signature: ___________________________________________ Date: ______________________
Donor Signature: ___________________________________________ Date: ______________________

PLEASE COMPLETE AND RETURN THIS FORM TO: (name, phone, and email of contact person)
The (lead organization) is here to assist you in fulfilling your philanthropic goals.