Gift Notification - Peterson Health Foundation

Date of estate plan or designation:

I have included a gift for Peterson Health Foundation through my:*

Will
Beneficiary Designation
Life Insurance Policy
Real Estate/Property
Stocks and Bonds
Other

Please specify:

Is this gift revocable or irrevocable?

This gift is revocable (can be changed).
This gift is irrevocable (cannot be changed).

Is this a percentage or a specified amount?

This gift is a percentage of my estate or account’s value.
This gift is a specified amount.

Please provide your best estimate of the current value of the gift designated for Peterson Health Foundation.

Please tell us about your gift designation:

I planned this gift in honor or in memory of someone.
I would like this gift to go to a specific program or purpose.
Peterson Health Foundation may use my gift where it is needed most.

Please provide the name or relationship with this person:

Please describe the intended program or purpose:

Peterson Health Foundation recognizes our incredibly generous legacy supporters with membership into our Heritage Society. By listing your name as part of this group in our publications, we hope you will inspire others to create their legacy through Peterson Health Foundation. Please let us know if you would like to be listed or if you prefer to remain anonymous.

Yes, please list my/our name(s) as part of Peterson Health Foundation publications.
No, please do not list my/our name(s).

Please list my/our name(s) as:

Please confirm your contact information:

First Name*

Last Name*

Address

Address 2

City

State

ZIP

Country

Phone

Email*

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Name

This field is for validation purposes and should be left unchanged.