Smithtown Township Arts Council
Memorial Donation Reply Form
Dec. 12
Yes, I would like to support the Smithtown Township Arts Council with its
mission to advance Suffolk communities through the arts and creativity!
Your Name: ______________________________________________________________________________________
Your full name(s) exactly as it should appear on donor lists
Address: _________________________________________________________________________________________
City, State, Zip: _________________________________________________________________________________
Email: ____________________________________________________________________________________________
This donation is made:
by the name indicated above
on behalf of: ______________________________________________________
in honor of: _______________________________________________________
in memory of: ______________________________________________________
Name: ___________________________________________________________________________________________
Address: ________________________________________________________________________________________
Yes, please send a Smithtown Township Arts Council acknowledgement of this
donation to the honoree or their family
Please keep anonymous the following (check all that apply)
donor's name
all details completely anonymous
on STAC website
Please mail this form and payment to:
(payable to Smithtown Township Arts Council) if you have made a credit card donation, check below:
we will match the email address on this form with your credit card payment from our website.
credit card payment
Smithtown Township Arts Council (STAC)
Mills Pond House 660 Route 25A,
St. James, NY 11780
Thank You! A formal gift acknowledgement letter will be mailed to you. Contributions in response to the Annual Giving appeal are tax
deductible to the fullest extent allowed by law. Smithtown Township Arts Council Inc. is a recognized 501 (c) (3) not-for-profit
organization, classified as a public charity under sections 509(a)(1) and 170(b)(1)(A)(vi) of the Internal Revenue Code. Federal
Identification Number: 11-2266741. Smithtown Township Arts Council www.stacarts.org 631-862-6575