American Cancer Society

American Cancer Society – Rochester Hope Lodge Donation Acknowledgement –Please Submit by March 16, 2012

Company/Individual:______(This Listing Will Appear on Printed Materials) Contact Person:______Address:______City/State/Zip:______Phone:______(ext. )______Email:

The American Cancer Society gratefully acknowledges the item(s) described below. Please keep this receipt. Donors do not receive any goods or services for their contributions. Therefore, your contribution is tax deductible to the fullest extent allowed by law.

Items donated and description:

______

Estimated “fair market value” of item(s) as determined by donor:

______

Please note: The American Cancer Society cannot attach a dollar value to your gift. For your record keeping purposes, please attach a proper dollar value to your gift. Federal tax laws impose certain appraisal and reporting obligations for charitable contributions of property other than cash, IRS Form 8283 and its instructions can assist you with your reporting obligations.

Donor signature:______ ACS Staff Date item accepted:______Accepted by:______ ACS Volunteer

 Received at ACS office  Picked up by ACS staff  Picked up by ACS volunteer

Item number:______

American Cancer Society representative signature:______

American Cancer Society, Midwest Division, Inc. Federal Tax ID #41-0724036 Organized under IRC 501(c)(3).

Event name: Rochester Hope Lodge “Evening of Hope” Event date: April 26, 2012 – Please return to the American Cancer Society Hope Lodge by March 16, 2012 Event location: Somerby Golf Community

Thank you for your donation to the American Cancer Society.

The information enclosed describes one or more of the American Cancer Society, Midwest Division, Inc.’s activities. Your gift is very much appreciated and tax deductible as a charitable contribution to the fullest extent allowed by law. A copy of our latest financial reporting may be obtained by writing to N19 W24350 Riverwood Drive, Waukesha, WI 53188 or by calling 1.800.ACS.2345. Mail: Hope Lodge, Gia DeMedici, 411 Second Street NW, Rochester, MN 55901 Email: [email protected]; Phone: 651.255.8162; FAX: 651.255.8133 ©2005 American Cancer Society, Midwest Division

Mail: Hope Lodge, Gia DeMedici, 411 Second Street NW, Rochester, MN 55901 Email: [email protected]; Phone: 651.255.8162; FAX: 651.255.8133