Virginia Historical Society

Annual Fund

Please print this form and mail to the Virginia Historical Society.

I / We wish to advance the mission of the Virginia Historical Society with a gift to the Annual Fund of:

Check box  $10,000      Check box  $5,000      Check box  $2,500      Check box  $1,000

Check box  $500      Check box  $250      Check box  $150      Check box  Other ______


Name(s):

Name(s)

Address:

Address

Address

City:

 City

State:

 State

Zip:

Zip


Check box I/We enclose a check made payable to the Virginia Historical Society.

Check box I/We wish to charge our gift to:   Check box Visa   Check box MasterCard

Account Number: Check boxes   Expiration Date: _________

Check box I/We enclose a matching gift form.

Check box I/We give permission for this support to be recognized in VHS publications.

Check box I/We prefer to remain anonymous.

Tax Information
The VHS has determined that contributions up to $999 are fully tax deductible. For contributions of $1,000 to $2,499, $123 is not deductible, and of $2,500 or more, $148 is not deductible if you use our facilities for a private event. You may opt out of this benefit to make your contribution fully tax deductible.

Check box  

I/We do not intend to make use of the facilities for a private party or special event, therefore, all of this contribution is tax deductible.

   
Check box  

I/We plan to make use of the facilities for a private party or special event, therefore, a portion of this contribution is not tax deductible.

A financial statement is available upon request from the Virginia Office of Consumer Affairs in the Department of Agriculture and Consumer Services.

Mail to: Catherine Boe, Annual Fund Manager, Virginia Historical Society, P.O. Box 7311, Richmond, VA 23221-0311

City
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