VEHICLE DONATION FORM - Lions Eye Foundation of …

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.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download