Make an online Legacy Pledge

Name(s):
Please print name(s) as you wish to be recognized.

Address:

City:

State:

Zip:

Home Phone:

Business Phone:

Mobile Phone:

Email Address:

Date(s) of birth: | | |

Electronic Signature:

Date:

______________________________

THE EPISCOPAL DIOCESE OF MISSISSIPPI HAS BEEN THE GRATEFUL RECIPIENT OF MANY GIFTS FROM GENEROUS MEMBERS who never notified us during their lifetimes. We encourage you to communicate your plans by completing this form. Doing so will allow us to thank and recognize you during your lifetime if you so desire, and will also allow us to keep you informed about the future use of your gift.

STATEMENT OF COMMITMENT

I/We have named the Diocese of Mississippi as a beneficiary in my/our
IRARetirement PlanLife Insurance Policy

I/We have established the following split-interest gift for the benefit of the Diocese of Mississippi:
Charitable Lead TrustCharitable Annuity TrustCharitable Remainder TrustCharitable Gift AnnuityCharitable Deferred Gift Annuity

Although addressing the requested information below is not required, your answers will greatly assist with the Diocese of Mississippi’s planning for the future. The specific terms of your gift will remain confidential. The Diocese of Mississippi understands that some types of gift expectancies are revocable and other types are irrevocable.

Please describe the details of your gift plan that will benefit the Diocese of Mississippi, and/or attach a copy of the relevant documents:

Please check the appropriate items:
Check here if your gift is to benefit the Gray Center.Check here if your gift is to benefit the Diocese of Mississippi for a ministry other than the Gray Center.Check here if your gift is to benefit your parish.
Name of parish (if applicable):

Additional Information:

Approximate dollar value if recorded as a percentage of the estate, or specific dollar amount if designated:

Please check one:
Include the name(s) as exactly referenced below in the public recognition documents of the Diocese of Mississippi.I/We prefer to remain anonymous for publicity purposes, but will accept other Legacy Gift benefits such as information and invitations.

The Seeds You Sow | The Campaign for Camp Bratton-Green and the Gray Center
The Episcopal Diocese of Mississippi
The Rev. Gates Elliott, Director of Development and Planned Giving
601.948.5954 • gelliott@dioms.orgwww.graycenter.org