Declaration of Intent

The Promise It is with deep satisfaction and an abiding commitment to my/our community that I/we sign this declaration in order to provide for future generations and assure continuity of services and programs in our Jewish community.

Please choose one: The following community partner organizations have ❒ I/We have already included a legacy gift for the Jewish been/will be included in my/our legacy plans: community in my/our estate plan. ❒ Robert M. Beren Academy OR ❒ Beth Yeshurun Day School ❒ I/We will leave a legacy gift and will formalize my/our gift ❒ within ______months. Congregation Beth Israel (affiliate) ❒ Congregation Brith Shalom

Donor Name (s) ______❒ The Emery/Weiner School ❒ Evelyn Rubenstein Jewish Community Center Date(s) of Birth ______❒ Holocaust Museum Houston Address ______❒ Houston Congregation for Reform Judaism ______❒ Houston Jewish Geriatric Foundation (benefitting Seven Acres Jewish Senior Care Services) Phone ______❒ Jewish Family Service Email ______❒ Jewish Federation of Greater Houston ❒ Seven Acres Jewish Senior Care Services My/our gift to the Jewish community was completed through a: ❒ The Shlenker School ❒ Bequest/Will ❒ Temple Beth Torah ❒ Retirement Plan Assets (IRA) ❒ Texas Friends of Chabad Lubavitch ❒ Gift of Life Insurance ❒ Torah Day School of Houston ❒ Other (please specify) ______❒ United Orthodox Synagogues of Houston Optional: The approximate value of my/our promise will be ❒ Yeshiva Torat Emet $______or ______%. ❒ Other ______

❒ I/We give permission to include my/our name(s) in a community-wide list of Create a Legacy donors to inspire and encourage others. It should appear as follows:______. ❒ I/We prefer to remain anonymous. Donor Signature(s) ______Date ______This declaration of intent is not a legal obligation and may be changed at donor’s discretion.

Please complete and return this form to the community partner or to: Create a Legacy Houston Jewish Community Foundation 5603 S. Braeswood Houston, Texas 77096 Contact Cindy Anapolsky at [email protected] or 713-729-7000 for more information.