DATE OF RECEIPT: __________________________________________
DONOR: ______________________________________________________
______________________________________________________
______________________________________________________
TYPE OF CONTRIBUTION: ____________________________________
AMOUNT OF CONTRIBUTION: ______________________________
ESTIMATE OF THE VALUE OF GOODS OR SERVICES
RECEIVED BY THE DONOR, IN CONNECTION WITH
THE CONTRIBUTION: ____________
The Internal Revenue Service has indicated that the amount of the charitable contribution is limited to the excess of the amount of cash (and/or property) contributed by the donor, over the value of any goods or services received by the donor in connection with the contribution. The above information should serve as a receipt in accordance with Internal Revenue Service regulations regarding charitable contributions after 1993, and should be kept with your income tax records.



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