Statement of Intent • Planned Giving • PBS North

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Donor Recognition(Required)

Yes, you may recognize me/us in donor lists and at events. Please list my/our name as indicated in the box below.

I/We prefer to remain anonymous during our lifetimes, but you may recognize me/us after my/our gift matures.

I/We prefer to remain anonymous.

Donor Name(Required)

Description of Gift

Bequest through Will or Revocable Trust

Charitable Trust

Real Estate

Other

IRA or Retirement Plan

My/Our Provision names Duluth Superior Area Educational Television, Inc. as the Beneficiary

I/we understand that, by stating an amount, my/our Estate is not legally bound by this statement and I/we may choose to add, subtract or revoke this bequest at any time, at my/our sole discretion.

Purpose of Future Gift(Required)

This gift is to be unrestricted and may be used where the need is greatest at WDSE WRPT

I/we wish to specify that this gift be used to support the following project(s) or purpose(s):

Project / Purpose(Required)

Signature of Donor(Required)

Today's Date(Required)

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Planned Giving Statement of Intent