Non-Cash Donation Report (General)

Donor Information

Declaration of Gift
Donee: Midland College

Donor/Company Name*

Conact Person (if company named above)*

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Property Transferred:

The undersigned, on behalf of the donor, does hereby assign, transfer, and set over unto the donee, all of the donor’s right, title and interest in and to the following (including serial number, if applicable):

Please add make/model, year and condition of the property*

Purpose of Gift:

The property hereby transferred is to be used and/or applied for the purpose indicated (please select desired purpose in the next section below, additional information may be required):

Unrestricted Use - For general use, with no restriction as to either the application of such property or the period of retention hereof and with full authority to sell or to donate the property to another non-profit agency and apply the proceeds from such sale for general charitable purposes of Midland College.

General Use by a Specific Program/Department - For the general use of a specific Program/Department as soon as reasonable possible or practical. Further, if the gift becomes no longer useful to the Program/Department, I grant full authority for its sale or other disposal and designate proceeds from such sale to the area of greatest need in the College.

Special Purpose as Follows

The property hereby transferred is to be used and/or applied for the purpose indicated (please check desired purpose):

Unrestricted Use General Use by a Specific Program/Department Special Purpose

Program or Department that should use donation

Describe the Special Purpose

Date of Donation*

Donor Signature*

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Title

Midland College Section (1 of 2)

Program/Department to receive donation

College Representative

First Name

Last Name

College Representative Title

Associated Costs - Transportation of gift, annual maintenance, etc. $

Description of Associated Costs

Charge to Account Number

Intended use and location of donation(s)

I have seen the item(s) to be donated or can otherwise verify the accuracy of the donation description in the Donor Section of the report, and I certify the applicability of this donation for the purpose for which it is being given to the College.

Signature of College Representative

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Date/Time

Midland College Section (2 of 2)

Midland College acknowledges receipt and ownership of the item(s) described herein.

Signature Executive Director of Institutional Advancement & MC Foundation

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Inventory Number

Date/Time