NAME



Preferred Broker and Account to use with Annual Pledge gifts.

NAME

Address

City, State, Zip Code

Date

Mr. John J. Broker

Broker’s full mailing address

City, State, Zip Code

Dear John,

I (we) would like to make an irrevocable gift of NNN (number of shares - spelled out) shares of XYZ Corporation (or shares or dollar value of shares of mutual fund(s)) from my (our) account number ##########. The gift is to the Church of the Good Samaritan, 212 West Lancaster Avenue, Paoli, PA 19301. Shares may be transferred to their account at Vanguard Brokerage services, account number 57395243. Their DTC number is 0062. Please contact Betsy Wolford, the Parish Accountant if you have any questions. Her phone number is 610-644-4040 x209. Thank you.

Yours truly

Signature(s)

All parties must sign

cc: Parish Accountant - Church of the Good Samaritan

This letter is current as of December 11, 2018

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