Estate Gift

I would like to leave Mokoma Conservancy *

a specific dollar amount from my estate

a % of estate of my estate's value

a % of the remainder of my estate

Gift Amount ($ or % assumed based on response above) *

I have included a gift to Mokoma Conservancy (Tax ID 23-3087977) through: *

Bequest in my Will

Trust Beneficiary

Life Insurance Policy

Retirement Plan

Securities

Other (please specify below)

If you answered other above, please explain here:

Restriction *

Unrestricted

Restricted to the below MC-mission aligned purpose (or its successor initiative)

If you selected restricted gift, please name the mission aligned program you would like your gift to go towards

First and Last Name *

Phone Number *

Street Address, City/Town, State, Zip Code *

Email Address *

As an expression of my desire to help advance land preservation, conservation education and training, and in recognition of my confidence in the Mokoma Conservancy and its mission, it is my intent to name Mokoma Conservancy (MC) as a beneficiary in my estate plan. *

I wish to be recognized as a member of the Legacy Society to help encourage others to make an exemplary commitment.

I prefer that my support remain anonymous.

Estate Gift Declaration of Intent