Heartly House, Inc.
Gift In Kind Donation Form
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Name as you would like to be recognized:
Contact (if other than donor):
Phone:
Address:
Email:
Description of donated item(s):
Restrictions or conditions that may apply to item:
Estimate of value: *
Signature:
Date:
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DD
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YYYY
Heartly House, Inc., is a nonprofit organization under section 501(c)(3) of the Internal Revenue Code; therefore your donation may be tax-deductible as allowable by law. Guidelines established by the IRS do not permit us to provide you with an estimated value of your contribution. Please retain a copy of this completed form for your records.
If you have questions about donations, visit heartlyhouse.org, or call 301-418-6610.
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