Fillable Printable In-kind Donation Form - New York
Fillable Printable In-kind Donation Form - New York
In-kind Donation Form - New York
Administrative offices
305 Seventh Avenue, 9
th
Floor
New York, NY 10001
212-243-7070
212-929-3412 (fax)
In-Kind Donation Form
Thank you very much for making an in-kind donation to Good Shepherd Services. This form will help us to properly record and acknowledge
your generous gift. If you have any questions, please contact Julie Beck at 212-243-7070, x244 or Julie_Beck@goodshepherds.org
Donation and Donor Information (to be filled out by donor)
I/we wish to donate the following item(s) to Good Shepherd Services as described below:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Estimated Value of the Donation
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: $__________________ Date of Donation: _______________________
Donor Name: _____________________________________________________________________________
Mailing Address: __________________________________________________________________________
Phone Number(s): _________________________________________________________________________
Email Address(es):_________________________________________________________________________
Special instructions, if any, including designated Good Shepherd program, if applicable. Attach additional
pages if necessary.
__________________________________________________________________
__________________________________________________________________
Signature of Donor: ________________________________________________________________________
Disbursement Information (to be filled out by Good Shepherd Services)
Program/Department: _____________________________________ Fiscal Code: ____________________
Program Contact: _________________________________________________________________________
Development Dept Contact: _________________________________________________________________
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The IRS requires, for our records and yours, that an estimation of the dollar amount of a non-cash contribution be
given. IRS publication 563, Determining the Value of Donated Property is helpful for individuals, partnerships, and
corporations who make non-cash contributions. If a non-cash contribution exceeds $500, the taxpayer must file IRS
Form 8283.
