Leaving a Legacy Gift to Our Mother of Perpetual Help School

The St. Alphonsus Liguori Society

Confidential Membership Information Form

The The St. Alphonsus Liguori Society recognizes individuals who have made the ultimate commitment to Our Mother of Perpetual Help School by including the organization in their estate plan. Members have identified themselves as our most ardent benefactors, and their devotion to our mission will be honored in perpetuity by inclusion in this special society.

Type of Gift

I/We have included OMPH School in my/our will:

A specific bequest of $_______________

A percentage bequest of _________%. Estimated value of $_______________________

Other (describe) $________________________________________________________________________________________________

Recognition (Select one.):

I/we accept membership into the The St. Alphonsus Liguori Society (recognition society for donors who have included Our Mother of Perpetual Help School in their estate plan). Please publish my/our name(s) among your lists of The St. Alphonsus Liguori Society members.
Please clearly print the text as it should appear: _____________________________________________

I/We have made OMPH School the beneficiary of:

A Qualified Retirement Plan (IRA, 401k, 403b)

• OMPH School interest: ____% Current market value of plan: $______________
• OMPH School is (check one): ____ Primary Beneficiary, ____ Secondary Beneficiary

A Life Insurance Policy

• OMPH School interest: ____%
• Death Benefit: $__________________ Cash Value: $______________________
• OMPH School is (check one): ____ Primary Beneficiary, ____ Secondary Beneficiary

I/We have provisions for OMPH School through another Planned Giving vehicle:

Describe: ______________________________________________________________________________________________________________________________________________________________________________________________________

Purpose of Gift:

Unrestricted

Restricted to the follow purpose or program: __________________________________

Documentation:

Yes, I/We will share a copy of the portion of my/our will that applies to OMPH School, or the change of beneficiary form in which OMPH School is named.

Authorization for use of name:

I/We authorize OMPH School to include my/our name(s) on the membership list of the The St. Alphonsus Liguori Society in official OMPH School publications and on public recognition devices. I/We understand that this authorization is limited to the use of my/our name(s) only, and that the type and amount of my/our gift will remain strictly confidential.

I/We prefer to remain anonymous.