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L'dor Vador Legacy Society Declaration of Intent Form
Please verify reCaptcha before submitting the form.
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Please select one:
I/We have already included a Legacy gift provision
I/We shall make a Legacy gift provision within the next 12 months
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Donor Signature(s):
By typing in your full name here, this acts as your digital signature. For multiple signatures, please separate names with a comma.
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Address Line 1:
Address Line 2:
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Address City:
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State:
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code:
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Mobile Phone Number:
Home Phone Number:
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Email:
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Date of Birth:
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I/We intend to make my/our gift to the permanent endowment fund of Or Ami through:
Please Select One
Gift in Will or Trust
Retirement Account
Life Insurance Policy
Cash
Assets: Securities, Real Estate, Other
Other (please specify below)
If "other," please specify here:
(Optional) The approximate value of my/our gift will be:
Please label your amount as a percentage OR monetary value in $.
I/We give permission to include my/our name(s) on a Legacy donor list to inspire and encourage others to join us. My/Our names should appear as follows:
I/We give permission to include my/our name(s) on a Legacy donor list to inspire and encourage others to join us. My/Our names should appear as follows:
I/We prefer to remain anonymous at this time
I/We prefer to remain anonymous at this time
In addition to my Legacy gift to Or Ami, I would also like to make a gift to the following organizations:
Any comments or additional info you would like us to know?
Tue, December 3 2024
2 Kislev 5785
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Tue, December 3 2024 2 Kislev 5785