First Name

Last Name

Street Address

City

State

Zip Code

I have named Ancillae-Assumpta Academy as a beneficiary in my will or living trust.

I will give:

a percentage of the estate a specific dollar amount

Indicate the percentage or current value of the portion

Indicate the outright bequest of a specific dollar amount

I have named Ancillae-Assumpta Academy as a beneficiary in a:

Retirement plan Life insurance policy Bank/Investment account

Administrator

Issuer

Institution

Purpose of gift to Ancillae-Assumpta Academy

Unrestricted Restricted

Restricted to:

Recognition

I would like my (our) name to appear in the Ancillae-Assumpta Academy Planned Giving Society membership I prefer to be an anonymous member of the Planned Giving Society

List my name as: