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Record of Donation Name of Donor(s): ________

Address of donor:_____________________________________________ City/State/Zip: _______________________________________________ Amount of Donation: $ Gift Type: Unrestricted Restricted If Restricted, please identify accepted uses for donation below: _______________

Date (Donor)
A copy of this will be sent to you upon receiving your donation. A Donation acknowledgement of your contribution to St. Mary’s Catholic School will also be provided pursuant to section 170(f) (8) of the Internal Revenue Code.