Fillable 1006 (Salt Lake County)

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1006 (Salt Lake County)

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The 1006 (Salt Lake County) form is 7 pages long and contains:

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  • 29 other fields

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1006

       

 
   

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 
 


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           
 

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 

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











which 


 

  









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


 
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1006
DECLARATION OF DEVISE, BEQUEST OR LEGACY
Value, in dollars (estimated by personal representative, or qualified appraiser):
Date of transfer in title/delivery of donation:
Any pertinent provisions or restrictions upon County’s use of the devise, bequest or legacy:
Signed: ___________________________________
Mayor, Elected Official, or Designee
Date: ____________________________________
ACCEPTANCE/NON-ACCEPTANCE
Salt Lake County hereby (accepts) (declines) the above devise, bequest or legacy. Acceptance is
made under the conditions specified within the Declaration of Devise, Bequest or Legacy Form.
Salt Lake County makes no judgment as to the value of devise, bequest or legacy.
SALT LAKE COUNTY COUNCIL
By _______________________________________
Chair
ATTEST:
_________________________________ __________________
County Clerk or Deputy County Clerk Date
Date: ____________________________________
Name and qualifications of appraiser, if applicable:
Description of devise, bequest or legacy::
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1006
DECLARATION OF DONATION
MAYOR OR ELECTED OFFICIAL APPROVAL
For Elected Official or Designee’s approval consistent with Policy 1006
(Cash donations $5,000 and under; Property donations $1,000 and under.)
DECLARATION OF DONATION
I, , irrevocably give, and where appropriate transfer, title to the property described
below to Salt Lake County to become permanent property of Salt Lake County and to be administered in
accordance with its established policies. I assign and transfer all rights, including any copyrights that I
possess on these properties to Salt Lake County, without restrictions or conditions except those noted below
under “Other provisions or restrictions.”
Description of donation:
Property Value (estimated by the donor):
Date of transfer of title and delivery:
Other provisions or restrictions:
__________________
Date
Donor Name:
Donor Address:
Salt Lake County hereby accepts the above donation under the conditions specified within this Declaration of Donation
form, but makes no judgment as to the value of the Donation.
__________________________________
_____
___________________________________
_________________, _______ _________
_______________________________________________________
Elected Official/Mayor or Designee
______________________________________
Please Print
Address
State
Zip
Donor Signature
____________________
______________________________________________________________________
___________________________________________________________________
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1006
(Cash donations above $5,000; property donations above $1,000; Testamentary donations.)
I, , irrevocably give, and where appropriate transfer, title to the property described
below to Salt Lake County to become permanent property of Salt Lake County and to be administered
in accordance with its established policies. I assign and transfer all rights, including any copyrights
that I possess on these properties to Salt Lake County, without restrictions or conditions except those noted
below under “Other provisions or restrictions.”
Description of donation:
Value (estimated by
the donor):
Date of transfer of title and delivery:
Other provisions or restrictions, if any:
__________________
Date
Donor Address:
Salt Lake County hereby accepts the above donation under the conditions specified within this Declaration of
Donation form, but makes no judgment as
to the
value
of
the
Donation.
SALT LAKE COUNTY COUNCIL:
________________________________________________
Chair
ATTEST:
___________________________________________________,
County Clerk or Deputy County Clerk
__________________________________
_________________________________________________________, _______ ____
_____
_______________________________________________________
Elected Official/Mayor or Designee
__________________
Date
______________________________________
Donor Name:
Please Print
Donor Signature
Address
State
Zip
DECLARATION OF DONATION
COUNCIL APPROVAL
For County Council’s approval consistent with Policy 1006
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1006 (Salt Lake County)

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Completed 14 February 2021

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