Bequest Intention Form Bequest Intention Form for the Boettcher Scholars Fund Name of donor(s)(Required)Preferred Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) I have made provisions for Boettcher Scholars Fund or the Boettcher Foundation in my estate plans as follows:(Required) Bequest in Will Beneficiary of a retirement plan Beneficiary of a Life Insurance Policy Component part of Fund: A separate foundation will hold the principal and provide income to Boettcher Scholars Fund. Other Bequest in Will Of a specific amount Percentage of estate in the following percentage Contingent Remainder Bequest Amount(Required)Percentage(Required)Please enter a number from 0 to 100.Remainder Bequest(Required)Beneficiary of a Life Insurance PolicyMax. file size: 50 MB. Beneficiary of a Retirement PlanMax. file size: 50 MB. Other(Required) Donor Advised Fund Revocable Living Trust Charitable Remainder Trust Other Please select one choice below:(Required) I would like to become a member of the Boettcher Scholars Fund Legacy Circle. I give my permission to publish my/my partner/spouse's name(s) in any written material as listed above. I would like to be a member of the Boettcher Scholars Fund Legacy Circle but would like to remain anonymous. Signature(Required)Date(Required) MM slash DD slash YYYY
