Bequest Confirmation Form

BEQUEST CONFIRMATION FORM

The Cornerstone of a healthy future.

A bequest in your Will is a simple, thoughtful way to reflect your vision for superior health care in your community in the future. If you have or intend to provide a bequest to the work of Quinte Healthcare – Trenton Memorial please complete and sign this Bequest Confirmation.

Details of your plans would be helpful in Trenton Memorial Hospital Foundation’s planning for the future if you wish to share them.

My bequest will be:

□ A percentage of the estate.

□ A specific amount.

□ The residue of my estate after the bequests are made.

□ A specific item of value. Details: ______

The intended, approximate amount of my bequest is:

$______or ______% of my estate.

The future of your bequest will make a significant impact on health care in our community.

Please indicate which area of work you want to benefit with your bequest gift:

□ Patient Care □ Equipment □ Building Projects □ Other

Trenton Memorial Hospital Foundation would like to thank you for the intended bequest gift in your will.

□ I authorize Trenton Memorial Hospital Foundation to list my name as one of “Cornerstone Society Members” who have taken a significant step to ensure superior health care in the future.

□ I wish to make my bequest confirmation anonymously.

Information about you

Full Name (Mr./) Mrs./Ms./Dr / Spouse’s Full Name (Mr./Mrs./Ms./Dr.) (if applicable)
Address (street and number) / Spouse’s Date of Birth (if applicable)
City Province Postal Code / Signature of Donor (mm/dd/yy)
Date of Birth (mm/dd/yy) / Signature of Joint Donor (If applicable) (mm/dd/yy)
Telephone (Home) (Work)

Please indicate how you would like your name to appear on our Donor Wall upon receipt of your gift?:

______

Trenton Memorial Hospital Foundation Planned Giving Department

242 King St., Trenton ON K8V 5S6 Phone: (613) 392-2540 ext 5403

Fax: (613) 392-3749 www.tmhfoundation.com