Form - Endowment Spendable Income Request

Endowment Spendable Income Request

Fund Name:*

Fund Number:*

Date*

Request to distribute spendable income in the amount of:*

Requested funds will be used for:*

If this is a scholarship fund, please include the recipient name(s) and award amount(s):*

Recipient Information:

Organization Name:*

Business Phone:*

Email*

Authorize Representative (name and title):*

Address:*

I (we) certify that the process stipulated in the Endowment Agreement for determining distribution requests has been followed and that this request is the result of that process. I (we) further certify that the purpose for which these funds will be used complies with the purpose of the Endowment Fund as stated in the Endowment Agreement.

If you need a copy of the Endowment Agreement prior to certifying to the above, please contact Gina Rhodes, Director of Planned Giving.

Committe Member / Business Manager (if no designated committee)*

Pastor / Principal*

CONTACT INFORMATION:
Gina M. Rhodes
Director of Planned Giving
Diocese of Charlotte
1123 South Church Street, Charlotte, NC 28203
704/370-3364
[email protected]

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