Charitable Gift Annuity Form

Erie County Public Library Foundation Inc. Endowment Partnership
Application for Charitable Gift Annuity (160 E. Front St., Erie, PA 16507)

Note: This program is made possible through an affiliation with The Erie Community Foundation for the benefit of the Erie County Public Library Foundation, Inc.. The Charitable Gift Annuity (CGA) will be issued, invested, managed and guaranteed by The Erie Community Foundation. Upon the death of the donor(s), the charitable remainder will become a designated endowment fund to perpetually benefit the participating charity.

I hereby apply for a Gift Annuity Agreement and wish to make the gift with:

Cash

Securities (cost basis: $ _______ )
Number of shares/type: __________ Name and symbol: __________

Other

I prefer to receive payments: Quarterly Semi-annually Annually
Donor: ____________________________________________________
Social security number: _______________ Date of birth: ___________
Address: ___________________________________________________
City: ____________ State: ____________ Zip code: ____________
Telephone: (day) _______________ (evening) _______________
Primary annuitant: _____________ Social security number: __________
Address (if different from above): _____________________________

For a two-life gift annuity, please complete the following information for the second annuitant:
Name: ____________________________________________________
Social security number: _______________ Date of birth: ___________
Address: ___________________________________________________
City: ____________ State: ____________ Zip code: ____________
Comments (if any): ___________________________________________

Signature of donor: ____________________ Application date: _________
Gift date: _________

Please complete and return to the Erie County Public Library Foundation or to Michael L. Batchelor, The Erie Community Foundation, 127 West 6th Street, Erie PA 16501, (814) 454-0843.

Erie County Public Library Foundation, Inc. Endowment Partnership

Sample Gift Annuity Rates

Two Lives:
Single Life
Joint & Survivor

Younger
Older
Rate
Age
Rate
50
55
5.4
50
5.7
60
65
6.2
55
6.0
70
70
6.6
60
6.4
70
72
6.7
62
6.6
75
77
7.1
65
6.7
77
80
7.4
67
6.9
80
82
7.8
70
7.2
82
85
8.3
75
7.9
85
90
9.2
80
8.9

Notes:

1. Charitable Gift Annuities (CGA’S) are a legal contract between the donor and the issuing charity: The Erie Community Foundation. CGA’s are primarily a gift. They should not be viewed as an investment. They quality for an immediate partial income tax deduction. A portion of your annual income may be tax-free. If appreciated securities are used, the capital gains tax due is spread over the life of the contract. Upon the death of the donor(s), the charitable remainder becomes a permanent endowment to perpetually benefit the charity of the donor’s choice.

2. The community Endowment Building Partnership is a no cost service of The Erie Community Foundation designed to help participating charities benefit from new endowment gifts funded through CGA’s.