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.

our

Bequest Information

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

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)

Other Use

Personal Information

Name

Address

Address 1

Address 2

City

ZIP / Postal Code

State / Province

Country

Date

Birthday

Spouse Birthday

Executor of Estate

Name of Executor

Address

Address 1

Address 2

City

ZIP / Postal Code

State / Province

Country

Phone

Signatures

Signature 1

Date

Signature 2

Date