Gift Annuity Illustration Request

This form can be used to request a charitable gift annuity illustration to be prepared for a prospective donor. The illustration you will receive will show annual annuity to the income beneficiary(ies). Payments are made quarterly. Click the Submit button below to send the request.

The LCF issues charitable gift annuities for one life or for two lives. Check one of the following:

One life

Two lives (payment to both jointly, continuing to the survivor)

Annuitant Information

Names, birth dates and relationships of persons to whom payments will be made.

First Recipient's Name:

First Recipient's Age/Date of Birth:

State of Residence:

Relationship to Donor:

Second Recipient's Name:

Second Recipient's Age/Date of Birth:

State of Residence:

Relationship to Donor:

Donor Information

Names, birth dates and states of residence of the Donors, if different from annuitants.

First Donor's Name:

State of Residence:

Second Donor's Name:

State of Residence:

The Gift

The Gift - Please indicate the donor's proposed gift:

Cash

Appreciated Mutual fund assets

Appreciated Publicly-traded securities

Value of gift:

Approximate cost basis of gift:

*Note in a husband-wife gift annuity funded with a stock or mutual fund, capital gains will be reported more favorably if the stock or mutual fund is in both spouses' names before gifting.

Donor's marginal federal income tax rate:

Payment Start Date:

Immediate payment

Deferred payment

Flexible Deferred payment

Deferred Gift Annuity

Must be defferred at least 1 year from gift date.

If deferred, please begin payments in:

Year:

Flexible Deferral Window

A flexible deferred gift annuity must be deferred at least 1 year from gift date. Deferral window's range cannot exceed 30 years beyond first date within deferral window.

Donor may elect payments to begin by:

Month:

Year:

Donor shall not defer first payment later than:

Year:

Financial Representative Information

Name:

Company:

Phone Number:

Address:

Address2:

City:

State:

ZIP:

Illustration Needed by:

Your E-mail:

Gift Story:

Send me a Gift Story presentation for this client.

See an example of a Gift Story Presentation. (Not available for flexible deferred gift annuities).

Comments:

The Lutheran Community Foundation

FINANCIAL REPRESENTATIVES