Appendix D "Donation Tracking - Contribution Acknowledgement" - Missouri

What Is Appendix D?

This is a legal form that was released by the Missouri Department of Mental Health - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2010;
  • The latest edition provided by the Missouri Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Appendix D by clicking the link below or browse more documents and templates provided by the Missouri Department of Mental Health.

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Download Appendix D "Donation Tracking - Contribution Acknowledgement" - Missouri

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Appendix D
(To be put on RO letterhead)
Contribution Acknowledgement
Thank you for your donation to the ________ Regional Office. We appreciate your generosity
and contribution which will be used to support people with developmental disabilities.
The __________Regional Office is considered a “charitable organization” under Section 170
(c) of the Internal Revenue Code and your donation may be considered to be a “charitable
contribution” for an income tax deduction. It is your responsibility to obtain acceptance from
the IRS for the fair market value you assigned to the item you donated.
Date: ___________________
Donor’s name: _________________________________________________________
Address: ______________________________________________________________
City: _________________________________________________________________
State: ___________ Zip: _____________ Phone: ___________________________
Description of item donated: _______________________________________________
Fair Market Value (assessed by the donor)
$______________________
___________________________________
Regional Office Director or Designee
If you have any questions, please contact us at __________________
Thanks again for your support!
1.030 Donation Tracking Policy
06.01.10
Appendix D
(To be put on RO letterhead)
Contribution Acknowledgement
Thank you for your donation to the ________ Regional Office. We appreciate your generosity
and contribution which will be used to support people with developmental disabilities.
The __________Regional Office is considered a “charitable organization” under Section 170
(c) of the Internal Revenue Code and your donation may be considered to be a “charitable
contribution” for an income tax deduction. It is your responsibility to obtain acceptance from
the IRS for the fair market value you assigned to the item you donated.
Date: ___________________
Donor’s name: _________________________________________________________
Address: ______________________________________________________________
City: _________________________________________________________________
State: ___________ Zip: _____________ Phone: ___________________________
Description of item donated: _______________________________________________
Fair Market Value (assessed by the donor)
$______________________
___________________________________
Regional Office Director or Designee
If you have any questions, please contact us at __________________
Thanks again for your support!
1.030 Donation Tracking Policy
06.01.10