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Stock Gift Notification Form

Thank you for your interest in supporting Unitarian Universalism! Before you make your gift of securities, please complete and submit this form to the Development Department at the Unitarian Universalist Association (UUA). The information you provide will help to ensure that the securities transfer goes as smoothly as possible and that the UUA credits your gift to the program you wish to support.

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	*	required fields
Personal Information
Email Address:	*
First Name:	*
Middle Initial:
Last Name:	*

Partner's First Name:
Partner's Middle Initial:
Partner's Last Name:
Address 1:
Address 2:
City:
State:
Postal Code:
Country:
Daytime Phone:
Evening Phone:
I/We belong to the following UU Congregation, Society or Fellowship:

I/We do not currently belong to any UU congregation.
The Asset
Please describe the assets you wish to transfer to the UUA. For example: "20 shares Intel common stock, approx. value of $1,000" Or "$10,000 from Vanguard mutual fund, account number 12345." Or "20 shares of Paper Products ‘r’ Us closely-held stock, estimated value of $2,500."

Date Acquired:
Cost Basis:
When do you plan to make this contribution?

If you are contributing closely held stock, please list the full name and address of the company, who we might contact regarding company repurchase, and how to reach them by telephone.

The Transfer
There are four ways to make a gift of securities to the UUA and they are listed below in order of their complexity. Please indicate which transfer option you intend to use for your contribution (more information).
Option 1 Re-register stock certificates in the UUA’s name.
Option 2 Transfer securities electronically. Please provide us with information about the company and individuals who will act as your agent in making an electronic transfer to the UUA’s agent.
Company or firm name, mailing address; telephone, fax and toll-free numbers:

Individual contact/your agent’s name, company; telephone, fax, and DTC numbers:

Option 3 Transfer securities by mail.
Option 4 Instruct your agent to transfer securities into an account for the UUA, sell the securities and send net proceeds to the UUA by check.
The Gift Purpose
This donation is given to the Friends of UUA, without supports current programs and services.
Please credit this gift to an outstanding pledge to the UUA (specify):

This donation is given to the UUA for the following specific purpose:

The Permission
Yes, the UUA has my/our permission to publish my/our name(s) in donor recognition lists (no amounts will be given). I/We would like my/our name(s) to appear as follows:

Please do not publish my/our name(s). I/we prefer to remain anonymous.

For more information contact giftinfoatuuadotorg.

Last updated on Monday, April 2, 2007.