PLANNED GIVING INTENTION FORM
Leave a Legacy of Dignity, Community, and Opportunity
Thank you for considering a planned gift to Blanchet House and our programs. Your future gift will help ensure that our work to alleviate suffering and offer hope for a better life continues for generations to come.
Important:
This form is not a legal document and does not amend or replace your will, trust, beneficiary designation, or other estate-planning documents. We encourage you to consult with an attorney, financial advisor, or tax and estate-planning professional.
1. DONOR INFORMATION
Name:
First Name
Last Name
Preferred Name:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Additional Donor / Joint Gift Name:
First Name
Last Name
Relationship:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
2. MY PLANNED GIFT TO BLANCHET HOUSE
I/we have made or intend to make a provision for Blanchet House through:
Bequest in my will or living trust
Beneficiary designation — IRA, 401(k), 403(b), retirement account, etc.
Life insurance
Charitable gift annuity
Charitable remainder trust
Charitable lead trust
Donor-advised fund
Retained life estate
Real estate
Stocks, securities, or other investments
Other
Gift Amount / Structure:
A specific dollar amount
A percentage of my estate
A specific asset or property
The remainder of my estate after other provisions
Other
Amount / Percentage / Description:
Approximate current value of gift:
*Providing an estimated value is optional and does not create a binding commitment.
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3. HOW I WOULD LIKE MY GIFT TO SUPPORT BLANCHET HOUSE
I/we would like this gift to support Blanchet House & Farm in the following way:
I/we would like this gift to support Blanchet House & Farm in the following way:
Support the general purposes and mission of Blanchet House
Meals and food services
Housing and supportive services
Services and programs for people experiencing homelessness
Blanchet Farm and opportunities for community, work and connection
An area or program of my choice
Establish or contribute to an endowment
I would like to discuss my wishes with Blanchet House
Additional instructions or wishes:
If you are considering a restricted gift, we recommend discussing your wishes with Blanchet House before finalizing your estate-planning documents. This helps ensure that your gift can be used as you intend and that your wishes remain workable as Blanchet House's programs and community needs evolve.
4. MY ESTATE-PLANNING PROFESSIONALS
Estate Planning Attorney
Estate Planning Attorney - Name
First Name
Last Name
Estate Planning Attorney - Firm
Estate Planning Attorney - Phone
Format: (000) 000-0000.
Estate Planning Attorney - Email
example@example.com
Financial Advisor / Wealth Manager
Financial Advisor / Wealth Manager - Name
First Name
Last Name
Financial Advisor / Wealth Manager - Firm
Financial Advisor / Wealth Manager - Phone
Format: (000) 000-0000.
Financial Advisor / Wealth Manager - Email
example@example.com
CPA / Tax Advisor
CPA / Tax Advisor - Name
First Name
Last Name
CPA / Tax Advisor - Firm
CPA / Tax Advisor - Phone
Format: (000) 000-0000.
CPA / Tax Advisor - Email
example@example.com
5. EXECUTOR / PERSONAL REPRESENTATIVE / TRUSTEE
Executor or Personal Representative
Executor or Personal Representative - Name
First Name
Last Name
Executor or Personal Representative - Relationship/Firm
Executor or Personal Representative - Phone
Format: (000) 000-0000.
Executor or Personal Representative - Email
example@example.com
Trustee (if applicable)
Trustee - Name
First Name
Last Name
Trustee - Relationship/Firm
Trustee - Phone
Format: (000) 000-0000.
Trustee - Email
example@example.com
Other Contact for My Estate
Other Contact - Name
First Name
Last Name
Other Contact - Relationship/Firm
Other Contact - Phone
Format: (000) 000-0000.
Other Contact - Email
example@example.com
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6. HOW I WOULD LIKE TO BE RECOGNIZED
I/we would like Blanchet House to recognize my/our planned gift as follows:
Recognition Options
I would like to be publicly recognized as a member of the Blanchet House Legacy Society.
I would like to be recognized anonymously.
I do not wish to be recognized at this time.
I would like to discuss recognition options with Blanchet House.
Please list my/our name as:
First Name
Last Name
Gift recognized in honor or memory of:
First Name
Last Name
Relationship:
7. BLANCHET HOUSE LEGACY SOCIETY
Blanchet House Legacy Society Options
I/we would like to be included in the Blanchet House Legacy Society.
I/we are already members of the Blanchet House Legacy Society.
Please contact me/us about Legacy Society membership and recognition.
I/we prefer not to participate in a legacy society.
8. NOTIFICATION OF MY PLANNED GIFT
Notification Options
I give Blanchet House permission to contact me to discuss my planned gift.
I would like Blanchet House to contact my estate-planning professional if additional information is needed.
I would like to provide a copy of the relevant section of my estate-planning document.
I prefer not to provide additional documentation at this time.
9. OPTIONAL DOCUMENTATION
Optional Documentation Options
I am enclosing a copy of the relevant provision.
I will provide documentation at a later date.
My attorney/advisor may provide documentation.
I do not wish to provide documentation.
*Please do not provide your complete will, trust, account numbers, Social Security number, or other confidential financial information unless specifically requested and securely arranged with Blanchet House.
10. WHAT INSPIRED YOU TO INCLUDE BLANCHET HOUSE IN YOUR FUTURE PLANS?
11. DONOR COMMENTS
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12. DONOR ACKNOWLEDGMENT
I/we have notified Blanchet House & Farm of my/our intention to include Blanchet House in my/our estate or financial plans.
Donor Intentions and Agreements
This form is an expression of my/our intentions and is not a legally binding contract.
My/our estate-planning documents control the distribution of my/our estate.
I/we may change my/our estate plans at any time.
Blanchet House will maintain information about my/our planned gift as confidential, subject to the recognition preferences indicated above.
I/we have been encouraged to consult with qualified legal, financial, and tax professionals regarding my/our planned gift.
Donor Signature:
Printed Name:
First Name
Last Name
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Donor Signature:
Printed Name:
First Name
Last Name
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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