DONOR INFORMATION (Please Type or Print)

Last Name _______________________________________________________First Name______________________________________________

Address _________________________________________________________________________________________________

City______________________________________________________ State ______________ Zip Code ___________________

Contact Phone: Home ( ) _____________________Business ( ) ____________________Email ___________________________________________

GIFT / PLEDGE INFORMATION

I (we) hereby contribute cash and/or assets to the City of Malibu’s Malibu Legacy Park Project Build the Legacy Campaign (Pledges of $5,000 or more  may be spread over a three-year period):

􀂆  I (we) wish to make a one-time gift of $ _______________

􀂆  I (we) pledge a total of $ _______________               􀂆  I (we) wish to have this donation pledge spread over 􀂆 1 􀂆 2 􀂆 3 year(s)

PAYMENT INFORMATION

􀂆 I (we) plan to make my (our) contribution in the form of: 􀂆 cash/check 􀂆 credit card

For Credit Card Payment: Please charge my credit card: 􀂆Visa 􀂆 MasterCard

Number _____________________________________________________________ Expiration Date ________________

Authorized Credit Card Signature ______________________________________________________________________

Please bill me beginning: Date ________, and thereafter 􀂆 semi-annually 􀂆 yearly 􀂆 other ___________

in the amount of $ ___________ per billing period.

PLEDGE PAYMENT SUMMARY Per Payment Amt Billing Periods + Matching Gift = Total Pledge Amount

I hereby pledge: ________________ x _______________ ____________ = ________________

You will receive my first pledge payment on: Date _______ 2008, and thereafter 􀂆 semi-annually 􀂆 yearly 􀂆 other ____

MATCHING GIFTS

My gift will be matched by _______________________________________________ Company/Foundation/Family

􀂆  Matching gift form enclosed 􀂆 Matching gift form will be forwarded to City of Malibu, Malibu Legacy Park Project

DONOR RECOGNITION/TRIBUTE (Donors will be recognized in campaign materials unless an anonymous gift is requested)

 􀂆 I (we) wish to apply our previous Malibu Legacy Park Project donation of $___________ and our new donation to the recognition level checked above.

Please use the following name(s) for recognition or tribute  ___________________________________________________________________

􀂆  I (we) wish to remain anonymous

DONOR SIGNATURE(S)

_______________________________________________________________________________________Date___________________________

PLEASE MAKE CHECKS & CORPORATE MATCHES PAYABLE TO: City of Malibu, Malibu Legacy Park Project

Mail your pledge to City of Malibu, Malibu Legacy Park Project, c/o Administrative Services, 24518 Stuart Ranch Rd., Malibu, CA  90265 or fax to (310) 456-3356.  Questions? Please contact Susan Shaw Noble at (310) 456-2489 or email info@malibulegacy.org.

While the City cannot give tax advice, you should note that donations to government agencies that are used for public purposes are deductible from income as charitable

contributions for Federal and State personal income tax purposes pursuant to Internal Revenue Code Section 170(a)(1) and (c)(2)(A) and California Revenue & Taxation Code Section 17201(a). Federal income tax laws limit deductions for charitable contributions to amounts in excess of the fair market value of goods or services provided in exchange for your contribution. Donors should contact their tax advisor relative to the deductibility of the donation.

   ___ Information Complete  ___ Legacy Campaign ___ Administrative Services       web

 

Gifts are cumulative.

* Gifts of $50,000 or more are eligible for recognition on designated park features. Please contact Susan Shaw Noble, 310.456.2489.

YES, WE WANT TO HELP FULFILL THE DREAM AND LEAVE A LEGACY:

THANK YOU!

DONOR AND PLEDGE FORM