Lifeline Recovery Center - Legacy Society

Confidential Letter of Intent

All information provided below will be treated strictly confidentially and will be used for Lifeline Recovery Center’s internal record-keeping purposes only (except for name listing recognition in the Lifeline publication along with other Legacy Society members, if applicable) and is not considered to be legally or financially binding.
Lifeline Recovery Center recognizes all those making legacy estate-planning provisions for it or any of its programs as members of its Legacy Society.

Please complete:
Name(s):*
Address:*

Street

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Recognition as a member(s) of the Legacy Society:*

My/our name/s may be published as a member(s) of the Legacy SocietyI/we prefer to remain anonymous
Name(s) as preferred for Legacy Society listing (if different from above):
Signature(s):

Clear
Date:*

MonthDayYear
Date
As an indication of my/our support for Lifeline Recovery Center, I/we am/are pleased to confirm that I/we have made a provision as follows (select all that apply):*

Bequest in my/our WillProvision in my/our Revocable Living TrustEstablishment of a Charitable Remainder TrustBeneficiary Designation in my/our Qualified Retirement PlanLife Insurance GiftOther
If other, please describe:
I/we conservatively estimate the current value of my/our provision to be approximately
$amount*. Lifeline Recovery Center recognizes that values are subject to change and dependent upon unforeseen circumstances. This information will be used only to help Lifeline project potential future financial support. This Letter of Intent is not considered to be a legally binding obligation or promise of any future donation to Lifeline and Lifeline recognizes such provision may be subject to revocation or modification at any time.
I/we would like my/our provision to be allocated as follows:
Area of Greatest Need Conservative value for “Area of Greatest Need” $
Area of Greatest Need Conservative value for “Men's Program” $
Area of Greatest Need Conservative value for “Women's Program” $
I/we worked with the following advisor to establish the gift:
Name:

First NameLast Name
Profession:
Firm Name:
Address:*

Street

Street Address Line 2

CityState / Province

Postal / Zip Code
Thank you for leaving a legacy!
Should be Empty:

Confidential Letter of Intent