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“Donation, Contribution, or Sponsorship Form”

Donation, Contribution, or Sponsorship Form

This form must be completed, signed, and turned in for all such occurrences greater than $250.

To be filled out by donor, contributor, or sponsor:

1.  Date of donation: ___________________________________  (Must be prior to donation or initiation of construction.)

2.  I am making this donation as (select one and fill in the legal name):

       a. An Individual ................................................Legal name:____________________________________

       b. An officer of a business................................Legal business name: __________________________

       c. An officer of a booster club with a tax id#....Legal club name: ______________________________

         For any of the above, if you wish this signed from to serve as a receipt from the authorized recipient for your own tax purposes, please provide the associated SSN, EIN, or TAX ID#:__________________________

       d. A representative of an informal group (not eligible for tax receipt)....Name:____________________

       e. Other (please describe) (not eligible for tax receipt).....____________________________________

3.  Type of donation:

       a. Cash, coin, check................................. Dollar amount: ____________________________________

       b. Supplies, equipment, property, etc....... Estimated value: __________________________________

       c. Volunteer Time....................................... Estimated worth: _________________________________

4.  Detailed description of what is being donated:______________________________________________________

__________________________________________________________________________________________________

5.  Program, school, department, class, or activity, if any, to which you restrict use of your donation.  Restricted funds will be used only for the named restriction: (Donations may not be restricted to use for an individual employee.)

__________________________________________________________________________________________________

6.  Representation: (Mark and sign appropriate one.)

       a. Monentary or property donor:

           I hereby certify that I hold legal title to the funds/property being donated, that I am authorized to make such donation, and hereby transfer full title of the funds/property being donated to the Wayne School District.

                  Signature: ________________________________________________________

       b. Volunteer:

           I hereby certify that I willingly donate my time and that I will not be compensated for my donated time by any source and that if I am given significant unsupervised access to a student in connection with my volunteer assignment, I must also obtain a volunteer form from the principal and complete it and submit it to Human Resources and be finger-printed.

               Signature: _________________________________________________________

To be filled out by district/school recipient:

Distribution                            Original to Accounting                               Copy to Donor                        Copy for School/Department