Connecticut Land Conservation Council · Statement of Intent Form

I am pleased to let CLCC know I have included it in my will.

I have included CLCC in my will or estate planning through (check all that apply):

a direct bequest of cash or securities

a direct bequest of real estate or other property

an IRA or other retirement plan

a life insurance policy

other

I prefer to keep this information private at this time.

If you selected 'other', please describe here

I wish my gift to be directed towards (check all that apply):

the most pressing needs

supporting land trust conservation and/or stewardship projects

education and capacity-building programs for land trusts

other

If you selected 'other', please describe here

Other instructions or comments

Please check the box that conveys your preferences:

I would like to be interviewed so that my story may inspire others

I am comfortable with my name being listed in CLCC’s Giving Circle to inspire others

I wish to be anonymous in all public materials

Your Legal Name

First Name

Last Name

How You'd Prefer to be Recognized

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

Verify Email

Phone Number

Upload Your Signature Here

Date

(mm/dd/yyyy)

Thank you for your leadership and conservation vision.

Land trusts and communities across Connecticut will greatly appreciate your gift.