Deferred Gift Certification

As an extension of our/my love for Christ's kingdom and commitment to Christian higher education at Dordt University, this is to certify that we/I have designated a bequest for Dordt University in my/our estate plan. my our

The bequest as specified in the will is:

A percent of the estate as follows:

A cash amount as follows:

Or, if you desire to specify a range for the bequest: More than $10,000, but less than $100,000 More than $100,000, but less than $250,000 More than $250,000, but less than $500,000 More than $500,000, but less than $1,000,000 More than $1,000,000, but less than $2,000,000 More than $2,000,000

Do you authorize Dordt University to publish your name(s) in printed material? Yes No

The bequest, when paid to Dordt University from our/my estate, shall be used by Dordt University as follows: Undesignated (as needed by the university) General Endowment Fund Capital Operations Endowment (please specify) Scholarships for deserving students Other (please specify)

Personal Information

Name

Street Address

City, State, Zip

Date

Birthday

Spouse Birthday

Executor of Estate

Name of Executor

Street Address

City, State, Zip

Phone

Signatures

Digital Signature

Date

Digital Signature

Date

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Giving to Dordt

Deferred Gift Certification

The bequest as specified in the will is:

Personal Information

Executor of Estate

Signatures