Charitable Contribution Acknowledgement Form
To Be Completed by Recipient Organization
The Revenue Reconciliation Act of 1993 requires that charitable contributions of $250 or more must be substantiated by a contemporaneous written acknowledgment from the organization receiving the donation (Internal Revenue Code Sec. 170(f)(8)). This acknowledgement includes the amount of cash and a description of any non-cash contributions donated to the organization. In addition, the organization is required to provide the donor a description and good faith estimate of the Fair Market Value (FMV) of any goods and services (round of golf, dinner, show, banners, etc.) received in return for the contribution.
In order to comply with this regulation, completion of this form will be required prior issuance of a check. Prompt completion will expedite processing.
Financial Donation Amount $1,000.00Today's Date 10/15/2021
PurposeIs the Community Organization receiving an In-Kind donation? ☐Yes ☐No(If YES In Kind Donation - Please describe the property received such as computers, artwork, furniture, etc.)
NameTax I.D. #AddressCity State Zip
Are contributions to your organization deductible as charitable donations?
☐ Yes, because we are a (check one): ☐ 501(c)(3) ☐ Government/School/Church ☐ Other (please describe):☐ No, because we are a (check one): ☐501(c)(6) ☐501(c)(4) ☐Other (please describe):
Will Pacific Western Bank receive any goods/services in return for this contribution? ☐Yes ☐NoIf YES, please indicate the benefits received by the bank and their value.Choose an item. Amount
CRA Qualified Donations
If this donation benefits low- to moderate-income individuals or community, please report the number of 1) low- to moderate-income individuals served, 2) small businesses served, or 3) affordable housing units built as a result of this donation.
Please return this form to (email address):_______________________ (Payment cannot be sent until this is received).
This does not read to me like a request for an acknowledgment. It's more of a "do you check the right boxes before we send money" type form. It probably has several purposes including: making things easier on the accounting side for the grantor by making sure no unwanted surprises are involved and helping track activity for the Community Reinvestment Act. It indicates on the form that payment won't be disbursed until the form is completed so I don't think there's an attempt to do anything nefarious here.
In answer to your general question though, as others have already pointed out, never send out an acknowledgment for a gift you haven't received.
Director of Gifts and Records Administration
Advancement and Alumni Relations
George Mason University
4400 University Drive, MSN 1A3
Fairfax, VA 22030
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