SDNHM: Live Oaks Society

Completing this form will provide the information needed to prepare a gift annuity illustration that will be emailed to you. Requests for gift annuity illustrations are reviewed daily and every attempt will be made to send your illustration by the next business day.

If you have any questions regarding the information requested, please call 619.934.0405.

Your name:

Date of birth:
(format xx/xx/xxxx)
Address:

Telephone number:

Email address:

If the gift annuity is for you and your spouse, please provide
spouse's name

Date of birth
(format xx/xx/xxxx)

If you wish to establish a gift annuity that makes lifetime payments to someone other than you or your spouse please provide
Name

Date of birth
(format xx/xx/xxxx)

If the gift annuity is to be funded with cash, please state the amount
$

If the gift annuity is to be funded with publicly traded securities, please state the estimated fair market value
$
State the cost basis (what you originally paid) of these securities
$
If you are not certain as to the exact cost basis, please estimate
$

If the asset being considered is something other than cash or publicly traded securities, please state the nature of the asset

The estimated fair market value
$
The known or estimated cost basis
$
If the asset is real property, is there debt and how much?
$

Please select your estimated federal income tax rate (select one)
25% 28% 33% 35%

If your state of residence is outside of California, please name the state

If you would you like us to send a copy of this illustration to your professional advisor please provide
Name

Email address

Telephone number

If you only know the telephone number and name we will be glad to look up the email address and forward the illustration.

If you do not have an email account and want your illustration sent by mail, please check this box
Send my illustration by regular mail

Gift Annuity Illustration Completing this form will provide the information needed to prepare a gift annuity illustration that will be emailed to you. Requests for gift annuity illustrations are reviewed daily and every attempt will be made to send your illustration by the next business day. If you have any questions regarding the information requested, please call 619.934.0405. Your name: Date of birth: (format xx/xx/xxxx) Address: Telephone number: Email address: If the gift annuity is for you and your spouse, please provide spouse's name Date of birth (format xx/xx/xxxx) If you wish to establish a gift annuity that makes lifetime payments to someone other than you or your spouse please provide Name Date of birth (format xx/xx/xxxx) If the gift annuity is to be funded with cash, please state the amount $ If the gift annuity is to be funded with publicly traded securities, please state the estimated fair market value $ State the cost basis (what you originally paid) of these securities $ If you are not certain as to the exact cost basis, please estimate $ If the asset being considered is something other than cash or publicly traded securities, please state the nature of the asset The estimated fair market value $ The known or estimated cost basis $ If the asset is real property, is there debt and how much? $ Please select your estimated federal income tax rate (select one) 25% 28% 33% 35% If your state of residence is outside of California, please name the state If you would you like us to send a copy of this illustration to your professional advisor please provide Name Email address Telephone number If you only know the telephone number and name we will be glad to look up the email address and forward the illustration. If you do not have an email account and want your illustration sent by mail, please check this box Send my illustration by regular mail