The purpose of this form is to provide notification to Saint Gregory’s Episcopal Church of the current intent of my/our legacy gift plan for the Church. This notification enables the Church to provide recognition during your lifetime (if approved by the donor) as well as to begin the customary documentation of these future gifts to Saint Gregory’s Episcopal Church. Please finalize your gift by making legal arrangements with your trusted professional advisors.

Donor Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number*

(###)

###

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Email Address* *

Name of the Executor of Your Estate or the Trustee of your Trust*

First Name

Last Name

Their Title/Relationship to You*

Executors Address*

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Executors Phone Number*

(###)

###

####

Executors Email*

My (our) gift is as follows:* *

A bequest in our Will or amended Will (codicil) - which leaves a dollar amount or percentage of a final estate

A beneficiary designation on a life insurance policy - either a policy where Saint Gregory's Episcopal Church is the sole beneficiary or a policy where Saint Gregory's Episcopal Church is listed as one of several beneficiaries or a specified percentage of the total death benefit

A beneficiary designation to a qualified retirement plan or an IRA qualified plan (all or a portion of remainder interest)

A remainder beneficiary for various Charitable Trust or Gift Annuities

A current gift of cash or publicly traded securities

I (we) desire our gift to be designated to one of the following donor-preferenced funds (please check one): * *

The General Fund

The Building Fund

The Legacy Fund

The Leadership Development Fund

The Outreach Fund

The Memorial Fund

The Community Life Fund

The Christian Formation Fund

If choosing life insurance, what type of policy (please check one)?* *

Permanent Whole Life

Universal Life

Variable Life

Term Survivorship Life

Name of Insurance Company and Policy Number*

The information stated on this form can be found on the following pages of my Last Will and Testament or Trust document that was signed on:*

I would like the intention of my gift to remain anonymous to the church body: * *

I would like my name to be listed on the Legacy Society rolls and plaque: *

Yes

How would you like your name/family name to appear on the plaque?*

Thank you!

St. Gregory’s Episcopal Church

Address: 6653 W. Chatfield Avenue, Littleton, CO 80128

Office Hours: Monday-Thursday, 9:00 a.m. to 3:00 p.m.

Main Phone: 303-979-5236