Download Gifts of Publicly Listed Securities / Shares Transfer Form Gift

Gifts of Publicly Listed Securities / Shares Transfer Form
Gift/Donation Form
Donor
Name: _____________________________________________________________________________________________
Address: ___________________________________________________________________________________________
City, Province: _____________________________________________________ Postal Code: ____________________
Daytime Phone Number: __________________________ E-mail: ___________________________________________
Donor’s Account
Financial Institution & CUID: ___________________________________ Account Number: ___________________
Name of Financial Advisor: _______________________________ Contact Phone Number: ____________________
Donation
Name of Security: __________________________________ Quantity: _________ CUSIP/ISN: __________________
Name of Security: __________________________________ Quantity: _________ CUSIP/ISN: __________________
Allocation of Donation (optional): _____________________________________________________________________
I understand that I will receive a gift-in-kind tax receipt for these securities from The Comox Valley Therapeutic Riding
Society for the closing price on the date these securities are received in the charity’s account. These securities have been
donated to The Comox Valley Therapeutic Riding Society without restriction and can be sold by the charity at their
discretion.
Signature of Donor:
Date:
The Comox Valley Therapeutic Riding Society
Receiving Firm:
Dealer/Rep #: 9485/9353
Account Number:
Name of Account:
Charitable Registration Number:
Raymond James Ltd.
FINS: T089
DTC #: 5076
CUID: MSLW
EURO CLEAR #: 91770
Charity account # 1G5YX0A0
THE COMOX VALLEY THERAPEUTIC RIDING SOCIETY
119228070 RR0001
A checklist for your reference:

Please call The Comox Valley Therapeutic Riding Society prior to initiating the transfer of securities, to
ensure that your gift is handled smoothly and efficiently. Charity’s phone #250-338-1968

Notify your financial advisor of your intention to make a gift of securities.

Give your financial advisor authorization to initiate the transfer on your behalf. This form, completed and
signed, should be sufficient for authorization.

Fax a copy of this signed form to Dee-Ann Mayburry at Raymond James Ltd. Fax # (250) 405-2499
If you have any questions please call Dee-Ann Mayburry’s assistant, Lenka Cepeova at (250) 405-2407.
Thank you for your generous support of The Comox Valley Therapeutic Riding Society!
Address: Box 3666, Courtenay, BC V9N 7P1 Ph: 250-338-1968 Fax: 250-338-4137 Email: [email protected]
*Form revised November 2012