Guardian Circle - Declaration of Intent Yes, I/We are committed to providing a planned gift to the Humane Society of Huron Valley (HSHV) and request that you accept my/our membership into the Guardian Circle of Donors. I/We have made a provision to support HSHV through my/our: Will Life Insurance Policy Retirement Plan Assets Trust Agreement Other (please specify)Other (please specify) For HSHV's long-term planning purposes, the current value of my/our gift is: Yes, I give permission to include my name on the list of Guardian Circle Donors. I would like my name to be listed as:Yes, I give permission to include my name on the list of Guardian Circle Donors. I would like my name to be listed as: I/We wish to remain anonymous No Yes I/We would like information on HSHV's Continuing Care program No Yes First Name * Last Name * Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Email Phone How do you prefer to be contacted? Email Phone Either Signature * Clear This declaration of intent is not legally binding. In the event of any future changes, however, we respectfully request that you notify the HSHV Development Department. THE INFORMATION BELOW MAY BE HELPFUL WHEN INCLUDING HSHV IN YOUR ESTATE PLANS: Legal Name: Humane Society of Huron Valley Address: 3100 Cherry Hill Rd, Ann Arbor, MI 48105 Tax ID Number: 38-1474931 Questions? Please contact Development@hshv.org or call (734) 661-3525 If you are human, leave this field blank. Submit
