Lupus Foundation MDV

TAX RECEIPT FOR DONATED GOODS

Thank you for your donation and support!

Donor please complete the following:

Description of goods donated

Goods valued at $

Donated on (date)

Your donation may be tax deductible, in accordance with applicable law.

Please follow IRS guidelines and obtain your own tax and legal advice. Please note

that your donation may be subject to a maximum deduction. We are not able

to provide acknowledgement of donated goods received. No cash donations

were received. Lupus America Communities did not provide the donor

with any goods or services in exchange for this donation. Values claimed

for income tax purposes are the sole responsibility of the donor.

Lupus America Communities

2121 K Street, Suite 200, Washington, DC 20037

(202) 349-1155 ¡¤

Tax ID 90-0870868

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