Recurring Gift Verification
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These forms are complex. Each field must be completed. “N/A” is not acceptable. Use
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where appropriate.
Date
Contributor Information
Contributor Name
Email
Phone
Fax
Development / Management Agent Information
Development Name
-- Select Development --
Buen Vecino Housing Complex
Ford City Motor Lofts
Oak Leaf Landings Phase I
Oak Leaf Landings Phase II
St. Cloud Villas Phase I
St. Cloud Villas Phase II
Tracey Manor
Email
Phone
Fax
Release Statement for Applicant/Resident
Printed Name
Typed Signature
Signature Date
Current Contribution
Current Contribution ($)
Frequency
Monthly
Quarterly
Annually
Other
Other (specify)
Changes Expected Within Next 12 Months?
No
Yes
Date of Expected Change
Anticipated Contribution ($)
Anticipated Frequency
Monthly
Quarterly
Annually
Other
Other (specify)
Contributor Signature
Printed Name
Typed Signature
Date
Submit Verification