501(c)(3) ORGANIZATION DONATION RECEIPT
Date: __________________
Name of Non-Profit Organization: ___________________________
Mailing Address: ______________________________________________________
EIN: __________________ (Find on the IRS Website)
Donor Information
Donor’s Name: _______________________
Donor’s Address: ________________________________________________________
Donation Information
Thank you for your donation with a value of ___________________________ Dollars
($_____________), made to the above-mentioned 501(c)(3) Non-Profit Organization.
Donation Description: ________________________________________________________
I, the undersigned representative, declare (or certify, verify, or state) under penalty of perjury
under the laws of the United States of America that there were no goods or services provided as
part of this donation. Furthermore, as of the date of this receipt the above-mentioned
organization is a current and valid 501(c)(3) non-profit organization in accordance with the
standards and regulations of the Internal Revenue Service (IRS).
Representative’s Signature ___________________________
Representative’s Name ___________________________
Title: _________________________ Date: __________________
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