Notification of Stock Transfer
First name:*
Last Name:*
Address: *
City/State/Zip:*
Date of Transfer:*
Type of shares:
Approximate value of the shares you intend to donate*
Transferring Broker's First and Last Name:
Brokerage Firm:*
In what state is the broker located?*
Broker's Phone Number
Directed to:*
 Unrestricted
 Building Fund
 Tuition Assistance
Notes:


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