Planned Gift Notification Form

NAME: _________________________________________
DATE OF BIRTH: _____________

SPOUSE’S NAME (if applicable): _________________________________________________

ADDRESS: ___________________________________________________________________

CITY, STATE, ZIP: ____________________________________________________________

HOME PHONE: _______________________  EMAIL: __________________________________

MY/OUR WILL, AND/OR OTHER ESTATE PLANNING DOCUMENTS, WHICH INCLUDE A PROVISION FOR THE JANAKA FOUNDATION or ANANDA, WERE EXECUTED ON:

MONTH/DAY/YEAR: _____________________

TYPE OF PLANNED GIFT:
__ BEQUEST UNDER WILL
__ IRA
__ LIFE INSURANCE
__ CHARITABLE INTEREST IN TRUST
__ CHARITABLE GIFT ANNUITY
__ REAL ESTATE

MY PLANNED GIFT IS STATED AS: 
1. __ A SPECIFIC AMOUNT
2. __ A PERCENTAGE OF ESTATE  (_____%)          
3. __ REMAINDER OF ESTATE

THE PURPOSE/DESIGNATION OF MY GIFT: ___________________________________________

________________________________________________________________________________

ATTORNEY/ADVISOR NAME:_____________________________
WORK PHONE: _____________
FIRM’S NAME: ______________________________________________________________________

ADDRESS: __________________________________________________________________________

____ I/WE WISH TO BE MEMBER(S) OF THE JANAKA LEGACY FELLOWSHIP

____ I/WE PREFER THIS GIFT TO REMAIN ANONYMOUS.

SIGNATURE: ____________________________________  DATE: __________________

SPOUSE SIGNATURE (if applicable): _________________________________
DATE: ____________