Fillable Gift Donation (San Diego Mesa College)

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Gift Donation (San Diego Mesa College)

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ATTACHMENT A
San Diego Community College District
3375 Camino Del Rio South
San Diego, California 92108-3883
GIFT/DONATION FORM AND TRANSFER OF TITLE
Donor Section
o DONATION DESCRIPTION: This description may be used for publicity purposes. Include all pertinent
information.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
o SERIAL NUMBER: __________________________________________________________
o DONOR’S ESTIMATED VALUE OF GIFT: _________________________________________________
(No employee/officer of the San Diego Community College District shall estimate the value of the gift.)
o The donor acknowledges that the San Diego Community College District reserves the right to sell or
otherwise dispose of this/these item(s) in whole or in its component parts, at the sole discretion of the San
Diego Community College District. The Donor further acknowledges that full title and ownership is turned
over to the San Diego Community College District, by signing below.
o DONOR SIGNATURE: ______________________________________ DATE: _________________
o DONOR NAME, ADDRESS, AND TELEPHONE NUMBER: ___________________________________
___________________________________________________________________________________
ACCEPTANCE REQUESTED BY
o ORIGINATOR: : ______________________________________________ DATE: _________________
o REQUEST FOR SERVICE #: ____________________________________ DATE: _________________
(If equipment needs installation or repair the site shall attach RS.)
o DIR OF ADMINISTRATIVE SVC: _________________________________ DATE: _________________
o RESPONSIBLE MANAGER: ____________________________________ DATE: _________________
(Vice President, Dean or other District Management staff)
I
t is expected that the Program Manager will send a copy of this form along with a thank you letter to the donor.
o RESPONSIBLE ADMINISTRATOR: : _____________________________ DATE: _________________
(President, Vice Chancellor)
FACILITIES SERVICES SECTION
o Related Costs or Needs Associated with Gift of Equipment:
a) Installations Costs: _____________________ By: _________________ Date: ____________
b) Restoration Costs: _____________________ By: _________________ Date: ____________
c) Relocation Costs: _____________________ By: _________________ Date: ____________
d) On-going Maintenance Costs: ___________________ By: _________________ Date: ____________
e) Additional Costs: _____________________ By: _________________ Date: ____________
f) Comments/Explanation: _____________________________________________________________
____________________________________________________________________________________
o Acceptance: Recommended: ____________________ Not Recommended: ____________________
o Vice Chancellor, Facilities Services Approval:
______________________________________________ Date: _______________________________
___________ NO DISTRICT MAINTENANCE
3/22/2013 ATTACHMENT B
ACKNOWLEDGEMENT OF CONTRIBUTION TO
SAN DIEGO COMMUNITY COLLEGE DISTRICT
1) Donor (include name, address, and telephone number: ________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2) Amount of cash or check contributed: _____________________________________________________
3) Description (but not estimate of value) of property (other than cash) contributed: ____________________
____________________________________________________________________________________
4) Date of receipt of contribution: ___________________________________________________________
5) ___________________ The San Diego Community College District did not provide any goods or
services in consideration, in whole or in part, for the cash or property contributed.
6) ___________________ The San Diego Community College District did provide goods and/or services in
consideration, in whole or in part, for the cash or property contributed.
a) Description of goods and/or services provided by San Diego Community College District in
consideration for the cash or property contributed: ________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
b) Good faith estimate of the value of goods and/or services provided by San Diego Community
College District: __________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
The undersigned officer of the San Diego Community College District hereby acknowledges the
contribution by Donor and provides the information stated above for Federal income tax purposes.
_____________________________________________________
Responsible Administrator
San Diego Community College District
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Gift Donation (San Diego Mesa College)

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Completed 21 July 2020

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