Contribute To Your Donor-Advised Fund Account

Transcription

1 Contribute To Your Donor-Advised Fund Account Questions or Need Assistance? Call Contributions to your donor-advised fund account ( Account ) can include marketable securities such as equities, mutual funds, fixed income and assets that are not publicly traded. To contribute restricted or non-cash assets or assets from an existing donor-advised fund or private foundation, call Donor Relations at or us at [email protected]. Contributions must be for a minimum of $500. All contributions are irrevocable, and are generally eligible for a tax deduction. Donating shares held less than a year may impact your deduction. Consult with your tax advisor. Donor-Advised Fund Account Number Select all that apply and complete the sections indicated. Transfer of assets from a Charles Schwab & Co., Inc. brokerage account: Complete Sections 01 and 05 Check or wire transfer: Complete Sections 02 and 05 Transfer of assets held at financial institutions other than Charles Schwab & Co., Inc.: Complete Sections 04 and 05 Security certificates held in personal possession: Complete Sections 03 and 05 Restricted stock or other assets: Please call for instructions Assets from an existing donor-advised fund or private foundation: Recommend a grant to your Account (such contributions are not tax deductible). Please call for further instructions All rights reserved. REF ( ) APP (12/15)

2 01 Complete the applicable sections for each type of contribution. For contributions from a third party, please make that designation in section 05 Authorize Contribution. Please indicate the name and address of each third party and the corresponding asset so that a receipt can be mailed to them for tax purposes. Assets to be transferred may be noted in a spreadsheet (one for each transferring institution if the assets are not coming from a Schwab account) and attached to this application. Each spreadsheet must be signed and dated by all account holders. Assets from a Charles Schwab & Co., Inc. BrokerageAccount Please identify each contributing Account Holder to ensure that each receives an appropriate acknowledgment for tax purposes. If contributions are being made by multiple Account Holders, clearly indicate which assets are contributed by which Account Holder in section 05 Multiple Account Holder Contributors. Schwab Brokerage Account Number Name(s) on Account Specify Assets 1. Stocks, Bonds, Mutual Funds or Other Assets (Use the table below only for specifying stocks, bonds, mutual funds or other assets) Description of Assets/Name of Security Additional assets may be listed in section 04b. For multiple lots, please include cost basis. 2. Cash Contribution: $ Symbol (if applicable) Number of Shares or All ** Approximate $ Value Total Cost Basis Include both price and date information. Purchase Price per Share ** Number of shares must be specified. will transfer assets based on the number of shares, not the approximate $ value since security values may fluctuate. Shares will be contributed based on a Schwab client s current cost basis method unless otherwise specified with a given purchase date and cost. 02 Check or Wire Transfer Check Enclosed: $ (Make payable to ) Wire Transfer: $ (Wire instructions are in Section 06.) 03 Security Certificates Please have all registered owners of the donated assets endorse each certificate by writing between the words appoint and attorney in the space provided on the back of the certificate. All registered owners must sign and date each certificate exactly as their name appears on the face of the certificate. Security Certificates Held In Personal Possession Specify Securities Name of Security Symbol (if applicable) Number of Shares Approximate $ Value Note: If you are sending security certificates, we suggest that you send them with this form via registered, certified or overnight mail, and request a return receipt. Note: Securities must be marketable and in most cases penny stock certificates are not accepted. Total All rights reserved. REF ( ) APP (12/15)

3 04 Check only ONE of the instruction boxes to the right, and follow the instructions as specified. For Assets Held at Financial Institutions Other than Charles Schwab & Co., Inc. HELPFUL TO KNOW All parties who are registered on the transferring firm s account(s) must sign part C of this section. I will initiate the transfer of assets by: Contacting the transferring financial institution directly for applicable procedures and forms. Instructing the transferring institution to provide any necessary information to using the delivery instructions in section 06 of this application. Delivering to the following: 1) Completed and signed Contribute to Your Donor-Advised Fund Account form (note: if transferring assets from more than one institution, complete this section 04 for each transferring institution) I hereby instruct to initiate the transfer by: Delivering to the following: 1) Completed and signed Contribute to Your Donor-Advised Fund Account form 2) Copy of a recent statement from the transferring institution (this statement must be dated no more than 90 days prior to the date it is sent) (note: if transferring assets from more than one institution, complete this section 04 for each transferring institution and please submit a separate statement for each institution) A. Transfer Details Financial Institution Name of Transferring Firm Name(s) on Account Account Number Firm Telephone Number Firm Mailing Address Firm Mailing City, State, Zip Code Account Account Number Name on Account Name on Account Continued on Next Page All rights reserved. REF ( ) APP (12/15)

4 04 continued B. Specify Assets Cash Contribution: $ Stocks, Bonds, Mutual Funds or Other Assets Description of Assets/Name of Security Symbol (if applicable) Number of Shares or All ** Approximate $ Value Cost Basis Include both price and date information. Purchase Price per Share Note: Depending on the type of securities and how quickly the securities are transferred by the financial institution currently holding the investments, a typical transfer initiated by will take approximately three weeks. ** Number of shares must be specified. will transfer assets based on the number of shares, not the approximate $ value since security values may fluctuate. Shares will be contributed based on a Schwab client s current cost basis method unless otherwise specified with a given purchase date and cost. Total C. Signature and s (for assets held at a financial institution other than Charles Schwab & Co., Inc.) With respect to transfers of assets from financial institutions other than Charles Schwab & Co. Inc. all account holders or authorized signers of the account(s) listed must sign below. By signing below, I/we acknowledge the existence of any differences in account owners and/or account type between the account from which assets are being transferred and the Account. Each individual above is aware of these discrepancies and authorizes to accept the transfer of assets between unlike accounts. By signing below, I/we hereby authorize the transfer of assets as listed in section 04 to. By signing below, I/we authorize any name or account discrepancy during the transfer All rights reserved. REF ( ) APP (12/15)

5 05 Authorize Contribution This is my written authorization to irrevocably transfer ownership of the assets specified in Sections 1, 2, 3 and/or 4 of this form (including restricted stock) to. I understand that any contribution, once accepted by Schwab Charitable, represents an irrevocable contribution to and is not refundable to me for any reason. IN CASE OF ERRORS OR DISCREPANCIES: If I find any errors or omissions relating to my Account, I must call immediately at I will notify no later than 10 days after the relevant communications are sent or made available to me. I understand that will not be liable for any losses that occur because of my failure to promptly notify of an error. is a 501(c)(3) independent, public charity. For Fax Submissions It is the intention of each of the undersigned Account Holders that Fund may rely on a facsimile copy of his or her signature as a binding and enforceable signature, admissible in any proceeding to the same extent as if this form was submitted in manual form. If an Account Holder has contributed multiple assets, please specify each asset. Multiple Account Holder Contributors Please indicate the name and address of each third party and the corresponding asset so that a receipt can be mailed to them for tax purposes. Third Party Contributors Mailing Address Mailing City, State, Zip Code Mailing Address Mailing City, State, Zip Code Mailing Address Mailing City, State, Zip Code is the name used for the combined programs and services of Fund, an independent nonprofit organization. Fund has entered into service agreements with certain affiliates of The Charles Schwab Corporation All rights reserved. REF ( ) APP (12/15)

6 06 Delivery Instructions When your form is complete, please review it, sign it and send it using one of the following options. Delivery Options Fax: (877) Regular Mail: Overnight Delivery: In case of fax delivery, please retain the original for your files. P.O. Box Orlando, FL Summit Park Dr. Suite 200 Orlando, FL Delivery Instructions All deliveries must include the Account Holder s name and the donor-advised fund account number. Wire Transfer Instructions: Wire to: Citibank N.A. 111 Wall Street New York, NY ABA#: FBO: Charles Schwab & Co., Inc. Citibank Account: Donor-Advised Fund Account Number: Account Holder Name: Forward Checks and Physical Delivery of Securities: 1958 Summit Park Dr. Suite 200 Orlando, FL All DTC-Eligible Securities (e.g., Stocks) Deliver to DTC Clearing 0164, Code 40 Tax ID #: Please include in the delivery instructions. Fed Book-entry Securities (e.g., Treasury Notes) JPM CHASE/CCC ABA#: Charles Schwab A/C G69873 FFC: Donor-Advised Account Number: All rights reserved. REF ( ) APP (12/15)