Stock Donation Form

Stock Donation 2025

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Name of stock/security being donated (ticker name & company)(Required)

Number of stocks/shares being donated(Required)

Current value of stocks/securities being donated(Required)

Date of Transfer(Required)

Transferring brokerage name(Required)

Transferring brokerage phone(Required)

Additional information or comments