DONATION RECEIPT REQUEST FORM

No goods or services were given in exchange for this donation. While City Net does track all donations, the valuation of any gift-in-kind donation is the privilege and responsibility of the donor. Please consult with your tax advisor if you need assistance with your donation valuation.

Date of Donation

YYYY

Donor Type

Individual

Organization

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Description of the in-kind donation (including quantity)

Is donation new?

(tags still on/unopened items)

Yes

Mix of New and Used

Project Designation

If other, where does the donation need to be designated?

Name of the person completing the form