keystonehumanservices.org

Response Request Form

There is no obligation on your part in requesting information or a personal analysis of your financial circumstances. Any information provided by you will be maintained in the strictest of confidences and any response by us is for your informational purposes only. If you do not wish to answer everything, please feel free to provide what you are comfortable telling us.

If you would prefer to mail or fax this information to us, please print this page and mail it or fax it (717 232-4597) to us.

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Information Request

Please contact me regarding:

  • Cash Gift
  • Appreciated Securities
  • Bequests
  • Charitable Gift Annuities
  • Real Estate
  • Gifts of Life Insurance
  • Gifts of Retirement Assets
  • Charitable Remainder Trusts
  • Bargain Sales
  • Retained Life Estate (definition)
  • Charitable Lead Trusts

Would you like to inform us of a bequest or other gift?

  • Yes, I have made a bequest or other legacy gift and would be pleased to have my name included as a donor.
  • Yes, I have made a bequest or other legacy gift but right now I would prefer to remain anonymous.

Calculation Request

With the following information, we will provide you with a calculation of your benefits using a Charitable Gift Annuity. There are other gift options that might be better suited for your individual financial circumstances which we will be glad to discuss with you. This is entirely confidential and the information you provide will be held in the strictest confidence.

Age:

If this annuity is to last for the lifetime of another person in addition to yourself, please enter that other person's age:

The dollar amount of the annuity you wish to establish:

If you wish to fund the annuity with appreciated assets, such as stocks, please indicate the original cost or basis of the assets (please disregard if the funding is to be with cash):

Our calculation will make assumptions as to the payout rate and the actual date of the gift. These assumptions are simply to give you a general idea of the income and tax benefits such a gift will provide you. There are other variables that may affect the actual benefits. This calculation is just a general idea of the benefits based on the current information and market conditions available at this time.

If you wish, you may set up the annuity now but defer the income to a future date. If so, please indicate the age (both ages if for two persons) at which you would like to start receiving annuity payments.

Your age at payment start:

Second person’s start age:

For more information or a confidential discussion of your charitable options, please email or call Ann Moffitt at 717 232-7509 ext. 133.

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