Leave a Legacy to Haven hospice and receive tax benefits while helping

Response Request Form

There is no obligation on your part in requesting information or a personal analysis of your financial circumstances. Any information provided by you will be maintained in the strictest of confidences and any response by us is for your informational purposes only. If you do not wish to answer everything, please feel free to provide what you are comfortable telling us.

If you would prefer to mail or fax this information to us, please print this page and mail it or fax it (352 379-6286) to us.

Your Name:
Your Title:
E-Mail Address:	(We must have this to respond to you by e-mail)
Phone Number:
Work Phone:
Mailing Address:

Information Request	Please contact me regarding: Cash Gift Appreciated Securities Bequests Charitable Gift Annuities Real Estate Gifts of Life Insurance Gifts of Retirement Assets Charitable Remainder Trusts Bargain Sales Retained Life Estate (definition) Charitable Lead Trusts
Would you like to inform us of a bequest or other gift?	Yes, I have made a bequest or other legacy gift and would be pleased to have my name included as a donor. Yes, I have made a bequest or other legacy gift but right now I would prefer to remain anonymous.
Additional Comments or Requests
Calculation Request.	With the following information, we will provide you with a calculation of your benefits using a Charitable Gift Annuity. There are other gift options that might be better suited for your individual financial circumstances which we will be glad to discuss with you. This is entirely confidential and the information you provide will be held in the strictest confidence. Age: If this annuity is to last for the lifetime of another person in addition to yourself, please enter that other person's age: The dollar amount of the annuity you wish to establish: If you wish to fund the annuity with appreciated assets, such as stocks, please indicate the original cost or basis of the assets (please disregard if the funding is to be with cash): Our calculation will make assumptions as to the payout rate and the actual date of the gift. These assumptions are simply to give you a general idea of the income and tax benefits such a gift will provide you. There are other variables that may affect the actual benefits. This calculation is just a general idea of the benefits based on the current information and market conditions available at this time. If you wish, you may set up the annuity now but defer the income to a future date. If so, please indicate the age (both ages if for two persons) at which you would like to start receiving annuity payments. Your age at payment start: Second person's start age:

TOP OF FORM

Please type the code shown in the image (it is case sensitive):

(sorry for the inconvenience - spam has made it a necessity)
This form protected by WebSpamProtect. JavaScript must be enabled in your browser to view this image.

Return to the Legacy Giving home page or to the Quick Guide to Legacy Gifts.

We would like to help make certain your intentions are executed accordingly. For more information about the importance of having a will, please email or call the Vice President of Development, Sharon A. Jones, at 352 379-6226. We are happy to answer questions and offer suggestions confidentially based on your personal circumstances.

Please note, individual financial circumstances will vary. The information on this site does not constitute legal or tax advice, either in whole or in part. Donor stories and photographs are for purposes of illustration only. As with all tax and estate planning, please consult your attorney or estate specialist. All material is copyrighted and is for viewing purposes only. Use of this site signifies your agreement with the terms of use. The content in this Gift Planning section has been developed for Haven Hospice by Future Focus. Please report any problems to section webmaster.

Planned Giving

Response Request Form