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Gift of Stock

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Name of Donor*

Answer required for "Name of Donor"

Email*

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Phone number*

Number Required

Name of Stock*

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Number of Shares*

Answer required for "Number of Shares"

Brokerage Company*

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Name of Broker

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Broker Phone Number*

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Date Executed*

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Method of Transfer*

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DTC Transfer

ABA Transfer

Designation of Giving*

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Annual Giving

Other Fund or Campaign