Capitol Land Trust · Legacy Club: Statement of Intent

Personal Information

Name

First Name

Last Name

Birth Date

(mm/dd/yyyy)

Email

Verify Email

Phone

Spouse/Partner Full Name (if applicable)

First Name

Last Name

Birth Date

(mm/dd/yyyy)

Email

Verify Email

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Intent & Purpose

It is my/our intention to leave an enduring gift to benefit Capitol Land Trust by making CLT the full or partial beneficiary of my/our:

Will (Bequest or Trust)

IRA

Real Property*

Life Insurance Policy

Retirement Plan

Other

If other, please describe:

*Real Property

If you are considering a donation of real estate, we ask that you connect with our staff to review the details of your wishes (sold to support land conservation or conserved forever), in order to align with CLT's Gift Acceptance Policies and Conservation Plan.

I/we would like our contribution to be used for:

Approximate Value

For Capitol Land Trust's purposes only, the estimated value of my/our legacy gift as of today's date is:

(enter only numbers, no symbols or commas please)

I/we prefer not to share the value of our intended legacy gift at this time.

Recognition

Name(s) as you wish to be listed:

Advisor

My/our attorney and/or financial advisor is:

Name

First Name

Last Name

Email

Verify Email

Phone

Finish

This form is not legally binding for donor or Capitol Land Trust; it is informational for CLT's records only.

Additional Notes

Please let us know if there is anything else you would like us to know.

Today's Date

(mm/dd/yyyy)