Donation Form Johnson County Young Matrons

DONATION FORM

JCYM Vision and Mission Statement

Johnson County Young Matrons (JCYM) is a service organization whose vision is to achieve a positive future for members of the community. This is accomplished through our mission to serve, support and promote philanthropies in our community. JCYM represents a diverse cross-section of Johnson County, Kansas and Missouri women, who share the belief that there is genuine need for "hands-on" personal assistance and financial aid in our own community. JCYM is a not-for-profit 501(c)(3) organization.

Office Use only

Date*

Date Submitted

Donor Information

Company Name

Contact First name:*

Contact Last name:*

Street address:*

City:*

State:*

Zip code:*

E-mail address:

Phone:*

Donation Information

Other Donation

Other Donation (please fill in dollar amount)

Account

Note

JCYM WAYS & MEANS

The success of JCYM"s fundraising efforts relies on donors like you. Your financial support is welcome at any time. 100% tax deductible subject to current tax laws*. JCYM is a 501(c)(3) not-for-profit organization.

Ways & Means Fund Donation (please fill in dollar amount)

"In Honor of" and "In Memory of" are optional

Ways & Means In Honor Of

Ways & Means In Memory Of

PLEASE NOTE:

If you would like the person, or family of the person, you are giving your donation in Honor of or in Memory of, to receive a note of your generous kindness please list a name and address for us. Thank you

Name - W&M

First NameLast Name

Address - W&M

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

JCYM CHARITABLE GIFT FUND

Your donation to this perpetual fund will allow JCYM to greatly impact our Philanthropies well into the future. 100% tax deductible subject to current tax laws*. JCYM is a 501(c)(3) not-for-profit organization.

Charitable Gift Fund Donation (please fill in dollar amount)

"In Honor of" and "In Memory of" are optional

Charitable Gift Fund In Honor Of

Charitable Gift Fund In Memory Of

PLEASE NOTE:

If you would like the person, or family of the person, you are giving your donation in Honor of or in Memory of, to receive a note of your generous kindness please list a name and address for us. Thank you

Name - CGF

First NameLast Name

Address - CGF

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

JCYM SCHOLARSHIP FUND

Welcomes your support of our Scholarship Program. Help deserving students fulfill their educational dreams. 100% tax deductible subject to current tax laws*. JCYM is a 501(c)(3) not-for-profit organization.

Scholarship Fund Donation (please fill in dollar amount)

"In Honor of" and "In Memory of" are optional

Scholarship Fund In Honor Of

Scholarship Fund In Memory Of

PLEASE NOTE:

If you would like the person, or family of the person, you are giving your donation in Honor of or in Memory of, to receive a note of your generous kindness please list a name and address for us. Thank you

Name - Schol

First NameLast Name

Address - Schol

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

JCYM THANKS YOU FOR YOUR SUPPORT

TAX INFORMATION: Please retain email receipt for your tax records. JCYM is a Not-For-Profit Corporation, #48-0721509, 501(c)(3) and donations are tax-deductible to the full extent of the law. No goods or services were provided for this gift. Please consult your tax advisor regarding specific questions about your deductions.

Johnson County Young Matrons, Inc., 7702 Mize Road, Shawnee, KS 66227-2911

*receipt will be emailed

Total Donation

Automated Total Fund Donation (total of all donations entered above)*

USDFund Donation

Check Amount

Date Ck Received

Check Number