Thank you for your intention to make a bequest to the UUFSMA Endowment Fund. We appreciate your making UUFSMA and its community work part of your personal legacy of generosity.
We are requesting the information below for a couple of reasons. One is to help the Endowment Fund Committee with its work to administer the Fund. The more important reason is that when the time comes, far in the future we hope, that your Bequest is received, we want to be able to honor you and to communicate to the congregation something about you and your reasons for the Bequest.Thank you for taking the time to complete the form.
I/we are completing this form to demonstrate my/our commitment to support the continued mission of the UUFSMA in my/our estate plans via a bequest to the UUFSMA Endowment Fund. I/we understand that completion of this form is not intended to be legally binding. It is a notification of my/our intention at this time.
Name(s): ______________________________________________________________________ Postal address: ______________________________________________________________________ Home phone: _____________________ Mobile phone: ______________________ Email address(es): ______________________________________________________________________ Please indicate your type(s) of planned bequest below: ____ Bequest of cash or securities in my/our will ____ Life insurance policy ____ Beneficiary on an asset; for example: ____ Retirement account or IRA ____ Donor advised fund account ____ Trust of some kind ____ Other: ________________________________________________________ Real estate at (address): ________________________________________________ ____ Other tangible property: ________________________________________________ ____ Other: ______________________________________________________________ Country where the will containing the bequest will be probated: ____ USA ____ Mexico ____ Canada ____ Other: ______________________________________________________________
(Optional) Estimated value at this time of your planned bequest: _______________________________ (Optional) Name and contact information for the Executor of your will: ______________________________________________________________________ ______________________________________________________________________ Have you placed any restrictions on the use of your bequest by UUFSMA? If so, please describe them here. If you need more space, please attach a separate page. Please also note the disclaimer below. ____________________________________________________________________________________________________________________________________________ I understand that if, in the judgment of the UUFSMA Board, changed circumstances should at some future time render the restricted use of this bequest no longer appropriate, then the Board shall use the bequest to further the objectives and purposes of UUFSMA, giving particular consideration to my special interest as described above. The Endowment Committee would like to know a little about you, to help us honor and acknowledge you at some time in the future when your bequest is received. We encourage you to write a statement for us with some biographical information and also some information on why you are choosing to leave a Bequest to UUFSMA.Please send us this statement with your completed form.
Statement provided?: ___ Yes ___ No Is there other information which you would like us to have? For example, are you making this bequest to honor someone’s memory? _________________________________________________________ ______________________________________________________________________ UUFSMA would like to thank and to recognize those who intend to leave a bequest to UUFSMA. We will occasionally publish in the UUFSMA newsletter or elsewhere the names of people who have notified us of their intended bequest. May we include your name on these lists, or do you prefer to remain anonymous? ____ Okay to include on lists. Name(s) as we would like them to appear: ______________________________________________________________________ ____ I/we prefer to be included on lists as “Anonymous”. Recognition includes membership in our Legacy Circle of those who have made gifts or plan bequests to the Endowment Fund. Would you like to be included in events of the Legacy Circle? ____ Yes ____ No
Acknowledgements: UUFSMA is a tax-exempt nonprofit organization recognized by Section 501(c)3 of the USA Internal Revenue Code. Bequests are deductible as allowed by law. UUFSMA does not provide guidance on estate planning or taxation. Please discuss your planned bequest with your financial and legal advisors. Bequests will be used at the discretion of UUFSMA as described in the UUFSMA Gift Acceptance Policy, a copy of which is available upon request. Please return this completed form and address any questions to the Chairman of the Endowment Fund committee. Signature ___________________________________ Date: _________________ Signature ____________________________________ Date: ________________
Endowment Fund committee use only: Name of committee member who received this form: ________________________________________________________ Date: ______________ What if any approvals are required by the Gift Acceptance Policy for this intended bequest: ______________________________________________________________________ Have the required approvals been obtained? ____________________________________ ______________________________________________________________________ Tracking identifier: ______________________________________________________________________ Any follow up required? _____________________________________________________ Has a short biography been prepared/provided? _________________________________ Has a statement of the reason for the Bequest been provided? ______________________ Has a photo been provided? __________________________________________________ Other notes: _______________________________________________________________
Unitarian Universalist Fellowship of San Miguel de Allende Apdo 798, San Miguel de Allende 37700 Guanajuato, Mexico