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 Revocable Trust Irrevocable Trust 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 AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email Phone How do you prefer to be contacted? EmailPhoneEither 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 Submit Δ
