Legacy Provision Form

CONFIDENTIAL

This document will provide a basis for credit given for your proposed gift and recognition in the Foundation’s Legacy Society, one of our Foundation’s most prestigious donor honorary organizations.

Name: _____________________________________________________________
Spouse: ____________________________________________________________

Mailing address:
Telephone: ____________________ Date of birth: _____________________
Spouse’s date of birth: _______________________
Name/Address of your estate advisor_____________________________________
___________________________________________________________________

TYPE OF PROVISION
I have included a specific or residual provision for the Foundation – Jewish Communities of Western CT, Inc. in my estate plan as follows:
a. Residuary Bequest; estimate of present value $___________
b. Outright Bequest of specific amount or asset $___________
c. Outright Bequest in my spouse’s estate plan $___________
d. Bequest in my Will if my spouse predeceases me and a similar $___________
bequest in my spouse’s Will if I predecease my spouse
e. Trust arrangement with the Foundation as the remainder beneficiary
________________________________________age:__________
________________________________________age:__________
Foundation percentage remainder interest _________% $___________
Current trustee: ______________________________________________
f. Designation of the Foundation as beneficiary of my qualified retirement plan
[IRA, 403(b), 401(k)] $___________
g. Other (please describe): _______________________________ $___________
_____________________________________________________
_____________________________________________________
TOTAL $___________