In-Kind Gift Form
Please complete this form to make a gift to the University of Arizona Department of Geosciences. Please return the
form to Alicia Saposnik. Fax: 520-621-2672 or scan and email to alicias@email.arizona.edu. For questions, please
contact alicias@email.arizona.edu or call 520-626-8204.
Donor/Company Name:
Contact Name:Phone:
Address:
Date of Gift:
Description of Property: (To create an itemized list, please see page 2)
Estimated total value (from above and page 2, if applicable. Please provide appraisal or other relevant value documentation, if available.) $
Donor’s signature:Date:
Accepted by the University of Arizona Geosciences Department.
Name:Title:
Signature:Date:
The University of Arizona federal tax ID number is 74-2652689. Please keep a copy of this form for your records.
Itemized List of Value (if needed)
Item description
Value
Total (put on page 1)
Pg. 2