JSSA Legacy Society

JSSA Legacy Society

Planned Gift Acknowledgement/Confirmation Form
Thank you for your commitment to supporting JSSA's future and the individuals we serve through your planned gift. Please complete this confidential form to confirm your intentions. All planned gifts received are directed to JSSA's endowment fund, managed by our Board of Directors.

As a result of your contribution, you will be recognized as a JSSA's Legacy Society member. Unless otherwise noted on this form, we will automatically list your name as a member. If you wish your gift to remain anonymous, please indicate that under the "recognition" section.
Person Filling Out the Form*

First NameLast Name
Spouse's Name (if applicable)

First NameLast Name
I/we confirm the following planned gift to the Jewish Social Service Agency (JSSA):*

Will or TrustLife Insurance PolicyCharitable Remainder TrustRetirement AssetsU.S. Savings BondCDs and Other Banking AccountsOther
[Optional] Would you be able to provide a percentage or amount of how much your gift would be from your estate?
Where would you like to designate your planned gift?*
You selected Existing Endowment Fund. Please let us know your Endowment Fund's name
I/we retain the right to change my/our mind(s) as to my/our designation of JSSA as a beneficiary, as to the purpose of my gift, and as to the portion and amount of my/our estate that will go to JSSA.

Members of the JSSA Legacy Society may be listed in the annual Report to Donors and in other JSSA publications or on the JSSA website.
Recognition Preferences*

I/we give permission to have my/our name(s) made public as a JSSA Legacy Society member (amount will not be stated).I/we wish to remain anonymous
In terms of Recognition, please use the following:
If you leave this blank, we will just state the "Estate of"