Donation Form

Instuctions:

* Use your browser to print this form.

* Fill in the information below.

* Include your donation payable to: Darien Lions Club Foundation

* Mail to the DLC Foundation address above.

___________________________________________________________

Name of Donor (Please print)

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Street Address

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City State Zip

___________________________________________________________

Phone

Donation Amount $____________ (Please do not send cash)

Detach at line (above). Send-in top portion / Retain lower section for your records.

Darien Lions Club Foundation
1702 Plainfield Road

Darien, IL 60561

Donation Reciept

You will be receiving as documentation of your gift an additional letter of thanks from the Darien Lions Club Foundation, which is a 501(c)(3) fully accredited foundation. Under Internal Revenue Service guidelines, the full amount of your payment maybe a deductible contribution. Please check with your tax advisor.

Donation Date _____/_____/_20_____

Donation Amount $____________

Contributions to the Darien Lions Club Foundation are 100% tax-deductible for income tax purposes to the extent provided by the IRS.

Federal Tax I.D. #36-4260549

Thank you for your donation!