Stock Power Form

The undersigned does hereby assign and transfer to the American Health Assistance Foundation:

Shares of Stock

____ Shares of the common stock of_______________

Represented by Certificate Number(s) ______________
____________________________________________
Inclusive, standing in the name of the undersigned on the books of said Corporation.

OR

____ Bonds of _________________________________
In the principal amount of $___________, Certificate Number_________________________
Standing in the name of the undersigned on the books of the said corporation.

The undersigned do(es) hereby irrevocably constitute and appoint Charles Schwab & Company to transfer the said stock(s), bond(s), or debenture(s), as the case may be, on the books of the said Corporation with full power of substitution in the premises.

Signed (Donor) _______________________________

Date___________________________

 

Signed (Donor - joint owner)______________________

Date___________________________

 


Donations to the American Health Assistance Foundation are tax-deductible under the Internal Revenue Code of the Internal Revenue Service for computing income and estate taxes. The American Health Assistance Foundation is a federally recognized 501(c)(3) non-profit, tax-exempt organization.

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