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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