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.
