Dear Donor,

We realize that many people who plan to support Ascension Sacred Heart Foundation through their estate and/or financial plans prefer to keep their intentions private. However, by letting us know of your plans, we can thank you during your life, and confirm that we are able to fulfill your stated intentions.

Please know that completing this form is non-binding — we understand that you may change your plans at any time. Please also know that all information you share with us is kept strictly confidential.

Janet Piepul
Major Gifts/Planned Giving Director
Ascension Sacred Heart Foundation
Phone: 850-278-3704


Planned Gift Notification—Confidential

Personal Information


Spouse Name:  ________________________________________________________________________

Address: _____________________________________________________________________________


Phone: ______________________________________________________________________________

Date(s) of Birth: _______________________________________________________________________

Your Gift Intention

Please provide the following information and attach a copy of the documentation or appropriate language from your will or trust, if available. Please complete all that apply.

  •  I/We want to support the mission of Ascension Sacred Heart Foundation through a planned gift as described below:
    •  I/We have included a bequest for Ascension Sacred Heart in my/our will or living trust.
    •  I/We have named Ascension Sacred Heart as a beneficiary of an asset:
      •  Retirement Plan
      •  Bank, Investment, or Other Financial Account
      •  Life Insurance Policy
      •  Other:__________________

The anticipated value of my/our gift is/will be approximately $_________or_______% of my/our estate. (If possible, please include a copy of the bequest language or other wording describing your planned gift.)

Please provide a general description of the gift provision (such as, asset to be donated if other than cash or securities, how gift is to be used, whether gift is to create an endowment, etc.):



  •  Yes, you may include me/us in listings of planned gift donors.

Please indicate how you would like your name(s) to appear in our Order of Cornette listings. (Please note the amount of your intended gift will not be published):


  •  No, please do not include me/us in listings.

Signature(s):                                                           Date:

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