Receipt No. __________
Tax ID Number (EIN): ____-____________________
Donated By: ____________________
Street Address: ____________________ City: ____________________
State: ____________________ Zip: __________
Donation Date: ____________________
Donation Value: $____________________
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 Signature: ______________________________
Print Name: ____________________
Thank you for your generosity. We appreciate your support!
click to sign
click to edit