Chandler Unified School District - Perry Bands

Chandler Unified School District

Extra Curricular Activity Tax Credit Contribution Form

Complete this form and return the completed form with your contribution to: Chandler Unified School District C/O Tax Credits 1525 W. Frye Road Chandler, AZ 85224

Contributor Information

First Name_____________ __ Mailing Address______________

__

_______________ Last Name___ _____

_____ ____ ______________

____________________________________________________________________________

City______________________________________________ State ______ ZIP ____________ ____ Phone____________ ___________ Method of Payment

If you would like to make a tax credit contribution using a credit card, debit card or e-check, please make your contribution on our secure online system.

To contribute online navigate to: taxcredit

Cash

Check

Money Order

Payable to:

Chandler Unified School District

Total Contribution Amount: $___________________

$$__________________________

Contribution Designation Please direct my contribution as needed

Please direct my contribution to one or more of the following schools (Contributions should equal the total contribution noted above):

$________ Andersen Elementary $________ Basha Elementary $________ Bologna Elementary $________ Carlson Elementary $________ Conley Elementary $________ CTA - Freedom Campus $________ CTA - Goodman Campus $________ CTA - Humphrey Campus $________ CTA - Independence Campus $________ CTA - Liberty Campus $________ Frye Elementary $________ Fulton Elementary $________ Galveston Elementary $________ Haley Elementary $________ Hancock Elementary

$________ Hartford Sylvia Encinas Elementary $________ Hull Elementary $________ Jacobson Elementary $________ Knox Elementary $________ Navarrete Elementary $________ Patterson Elementary $________ Riggs Elementary $________ Ryan Elementary $________ Sanborn Elementary $________ San Marcos Elementary $________ Santan Elementary $________ Shumway Elementary $________ Tarwater Elementary $________ Weinberg Elementary

$________ Andersen Jr High $________ AZ College Prep - Oakland $________ Bogle Jr High $________ Payne Jr High $________ Santan Jr High $________ Willis Jr High

$________ AZ College Prep ? Erie $________ Basha High $________ Chandler High $________ Hamilton High $________ Perry High

$________ Chandler Early College $________ Hill Academy

I wish to designate this money for (Optional): General Extracurricular Activities ? direct as needed Specific Eligible Activities:

$________

Activity or Grade Level

Student First Name

Student Last Name

_____P_e__r__r_y____B_a__n_d__s____________________________________________________________________________

$________ _________________________________________________________________________________________________

$________ _________________________________________________________________________________________________

$________ _________________________________________________________________________________________________

For Chandler Unified School District Use Only

Received By:___________________________________________ Total Received: $___________________ Date:________________

This contribution is eligible for the Arizona State income tax credit as allowed by ARS ? 43-1089.01. Up to $200 per individual and up to $400 for married couples filing jointly can be claimed on personal income taxes. An official receipt will be mailed to the address provided by January 1. Contributions are non-refundable by the Chandler Unified School District. Please consult your personal tax advisor to determine the application of the credit.

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