Application

CHARITABLE REMAINDER TRUST APPLICATION
(Minimum funding amount $150,000.00)

Name of Donor:
DOB:
Phone Number:
E-mail Address:
Mailing Address:

Name of Beneficiary:
DOB:
Phone Number:
E-mail Address:
Mailing Address:

Type of Asset: __ Cash
                              __ Publicly Traded Stock
                              __ Closely held stock
                              __ Real property
                              __ Other - Specifiy:_____________________________

Anticipated funding amount:

Are the assets held in trust: __ yes  __ no

If closely held, type of corporate entity: __ S-corp  __ C-corp  __ LLC  __ Paternership

If closely held, real property, is there debt (leveraged, mortgage) __ yes  __ no  
 If yes, please describe:

* If real property, please include a copy of the deed of record.

If closely held, is there a Buy/Sell agreement:

Name of Attorney:
Phone Number:
E-mail Address:
Fax:
Mailing Address:

Name of Accountant:
Phone Number:
E-mail Address:
Fax:
Mailing Address:

Qualified appraisal (Describe & when required)
Purpose of Gift:  __ Gift to TMC
                                  __ Current income
                                 __ Retirement supplement
                                 __ Income/remainder gift to grow

(Describe TMC/CSTGE Disclosures that we will provide:)
 __ T'ee/investments/fees/Kaspick & Co.

No other goods or services were provided in consideration for this contribution. PLEASE REVIEW THESE FIGURES WITH YOUR TAX COUNSEL.

 

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