Legacy Society Form

I/We have made a provision for Meals on Wheels Western Michigan in my/our estate plan, as follows.

Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best Number to Reach You*
Email*
Description of Gift*
- Bequest in will or trust
- Beneficiary of life insurance plan
- Beneficiary of retirement plan
- Real estate
- Tangible personal property
- Other
Please attach a copy of the legal documents pertinent to this gift
The approximate anticipated value of this gift
Meals on Wheels Western Michigan periodically publishes a list of Legacy Giving Society members. We hope this will encourage others to make similar gifts. We would be honored to list your name unless you prefer to remain anonymous. All details about the amount or type of gift will remain confidential.

Please list my/our name(s) as the following
Please do not publish my/our name(s) in connection with the Legacy Giving Society.
This statement of intent does not constitute a legally binding pledge or agreement for me or for my estate. It documents only my intent, and may be amended at any time.*
- Acknowledged
Today's Date*
Date Format: MM slash DD slash YYYY