Annuity Prospect Form

The following information is needed to calculate an annuity.
Program: AHAF, ADR, MDR, or NGR

One-or Two-Life Plan:_______________________________________________

Name of Annuitant(s):_______________________________________________

Street Address:____________________________________________________

City, State, Zip:____________________________________________________

Telephone Number:_________________________________________________

Date(s) of Birth:___________________________________________________
(Participants must be 60 years old or older to receive annuity payment.)

Annuity Amount:___________________________________________________
(An annuity must be at least $10,000.00)

Once the above information is received by AHAF, a no-obligation annuity proposal will be mailed to you within 24 hours.

If you want an example of the annuity benefits we can insert this:

In the year you make an annuity, you are entitled to an income tax deduction for a portion of the amount you transfer. Another benefit is that part of each annual payment you receive is tax-free.

Example. Jane Doe funds a $10,000 gift annuity. Based on her age, she will receive 8% or $800.00 each year for the rest of her life. About $420 of each payment is tax-free over her life expectancy. Jane Doe will also receive a charitable income tax deduction of approximately $4,400.00, which she can deduct on her federal income tax return in the year of the gift. (In order to get this deduction you have to file the long IRS tax form).

Our mailing address:

Barbara Spitzer, Gift Planning Officer
American Health Assistance Foundation
22512 Gateway Center Drive
Clarksburg, Maryland 20871

Last Review: 09/27/11