Donation Tax Receipt

Please complete this form and we will send you a copy of your 501c3 return in January of the appropriate tax year.

Donation from:

Name

First Name

Last Name

Organization Name

If this is for an individual, please leave the field blank or write "N/A".

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

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###

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