DONOR APPLICATION FORM

FOR A FAMILY FOUNDATION ACCOUNT

(Print this page to mail, or fax to 801 359-4410)

Section 1: Donor Information

Unless otherwise requested and specified, the Donors of a family foundation have full and equal rights to
recommend grants and to appoint successor charitable advisors to the foundation. For two or more donors,
all foundation correspondence will be sent to Donor 1 if the mailing addresses are different.

Donor 1
Name
Mailing Address
City, State, Zip
Name to be used for all correspondence
Date of Birth	Age	Home Phone
Social Security Number (required)		Business Phone
E-mail Address

Donor 2

Name

Mailing Address

City, State, Zip

Name to be used for all correspondence

Date of Birth

Age

Home Phone

Social Security Number (required)

Business Phone

E-mail Address

SUCCESSOR CHARITABLE ADVISOR 

Person appointed to make grant recommendations if Donor(s ) are no longer willing or able.

Name

Mailing Address

City, State, Zip

Relationship to Donor (s)

Home Phone

Home Phone

Business Phone

Section 2: Name Your Foundation account

Donors have the opportunity to name their family foundation. A letter, which highlights the name of
your family foundation and the name of the donor, will accompany grants made from your family
foundation to charities, unless anonymity is requested.

Family Foundation Account Name

Section 3: Contribution

Contribution: $5,000 minimum initial contribution into a component family foundation.  Please make
checks payable to The American Foundation of Utah.  To wire funds or contribute stocks please call
(801) 359-3505 for assistance.  Note: Securities held for one year or less are deductible at the lesser
of cost basis or fair market value.

Section 4: Acknowledgement

I acknowledge that I have read The American Foundation of Utah's "Turnkey Family Foundation Program" information
and hereby agree with its Policies and Procedures. I also express my desire to support The American
Foundation of Utah’s charitable mission and objectives, especially their programs to assist and benefit charities that I
recommend.

I understand that any donation or gift I make to The American Foundation of Utah, The American
Foundation for Charitable Support, or any it its Family of Foundations represents a completed, unrestricted,
charitable gift or contribution and is not refundable to me.

I hereby certify that, to the best of my knowledge, all information presented in connection with this application is accurate, and I will promptly notify The American Foundation of Utah in writing of any changes.

I acknowledge that one percent (1%) of the asset value of my/our family foundation will be transferred as an internal gift allocation to The American Foundation of Utahs operating account annually.

Donor 1 Signature	Date
Donor 2 Signature	Date

(Please attach any additional donor signatures.)

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