VEHICLE DONATION FORM - Lions Eye Foundation of …
[Pages:1]Lions Eye Foundation of California-Nevada, Inc. P.O. Box 7999
San Francisco, CA 94120
PRESERVING THE GIFT OF SIGHT
VEHICLE DONATION FORM (EIN 94-1676055)
NAME _______________________________
HOME PHONE ______________
ADDRESS ____________________________
BUS. PHONE ______________
____________________________
I wish to donate the following vehicle to the Lions Eye Foundation of California-Nevada, Inc.
CAR TRUCK BOAT RV OTHER, Describe ____________________
MAKE/MODEL/YEAR ____________________________________
LICENSE NO. ________________________ ID NO. __________________________
MILES ___________ PASSED SMOG ON ____________
REGISTERED YEAR NEW ____________ TITLE YEAR NEW ____________
FAIR MARKET VALUE $ ________ VEHICLE LOCATION _____________________
Please check with your professional tax advisor for tax reporting compliance requirements.
____________________________
Donor signature
_____________
date
____________________________
LEF Agent signature
_____________
date
Please mail this form to: PAT BATTAGLIA, VEHICLE DONATIONS CHAIR 11 Michael Court San Carlos, CA 94070
You will be contacted by Pat Battaglia who has more than 28 years of Automobile business experience.
Thank you for your generosity.
The Lions Eye Foundation of California-Nevada, Inc. preserves and restores the gift of sight by providing free opthalmic examinations, operations, and medication to the less fortunate members of our community.
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