Mesa Public Schools



Extracurricular Activity Donation

Phone No.

Contributor/Taxpayer ______________________________

Address

STREET CITY STATE ZIP CODE

|School Name(s) |Activity |Amount |

|Dobson High School |Spiritline | |

| | | |

| Total Amount Contributed | |

The above payment is eligible for the Arizona state income tax credit as allowed by Arizona Revised Statute §43-1089.01. The tax credit is limited to $400 for married couples and $200 for individuals. A receipt will be mailed to you for tax purposes. Donations are nonrefundable by the school district. Please consult your personal tax advisor to determine the application of the credit.

Paying by Credit Card

Paying by credit card – please go to our secure site pay and select ECA State Tax Credit

Donate On-Line. If you do not have Internet access, please complete this section.

( MasterCard ( VISA Card Number

Expiration Date: ______ Signature

Complete the credit card information and fax this form to (480) 472-0107 or mail to the address below.

Due Date: To be eligible for an Arizona State tax credit, your contributions must be postmarked by December 31st.

Paying by Check:

Please make checks payable to Mesa Public Schools and mail with this form to the address below.

Drop-off Locations: 63 East Main Street, Accounting Department 6th Floor – 7:30 a.m. to 4:30 p.m.

Mailing Address:

ECA Tax Credit, Mesa Public Schools, 63 East Main Street #101, Mesa, AZ 85201-7422

Mesa Public Schools will make every effort to ensure that donations are used for the activity specified. However, in the unlikely event that an activity is cancelled or receives more funding than is needed, the school will use your donation for another worthwhile activity that directly benefits students. If no activity is listed, the School Improvement Advisory Council will determine the extracurricular activity of greatest benefit. Be assured that your donations will not fund recreational, amusement or tourist side trips.

For answers to any questions please, contact Mesa Public Schools Student Funds supervisor at (480) 472-0133.

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Extracurricular Activity Donation

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