Statement of Future Gift

Thank you for including a gift in your estate plan, which will help sustain and strengthen the University of Minnesota. This form is to help you provide information about your gift to ensure that it will be used in accordance with your wishes.

Full name*

Date of birth*

Second name (if joint gift)

Date of birth

Phone number

E-mail address

Address*

City*

State*

Zip*

I/we have made a provision for this gift through a*

Will or trust Donor advised fund remainder* Charitable remainder trust (please attach copy) IRA/retirement plan* Life insurance*

Other:

*Name of organization/company where the assets are held:

I/we designate this gift

For long-term planning purposes, the estimated value of my/our gift as of this date is

(If your gift is a percentage of your estate, or a specific asset, please indicate the approximate current value of your gift.)

Any supporting information you are willing to share with us, including a copy of the gift provisions for the University and contact information for your personal representative or trustee, would help us in administering your gift. We understand the value and type of your gift may change over time, and would appreciate notification of such changes. Any information you share will be kept confidential.

All donors of estate or other planned gifts become members of the Heritage Society of the University of Minnesota President’s Club.*

Please do not publish my/our name(s). Please publish my/our name(s) as follows:

This document does not create a binding commitment. By signing this form, you are simply acknowledging your current plans to benefit the University and giving us direction as to your wishes.*

Date*

Format: MM/DD/YYYY

I agree that printing my name and the current date will serve as my electronic signature.*

I agree