Begin a Charitable Project U.S. Family Foundation, Inc. -Application- To Begin a Charitable Project 12345 DESIRED NAME FOR CHARITABLE PROJECT* Applicant Name:* First Last Date of Birth:* Month Day Year Spouse: First Last Date of Birth: Month Day Year Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number (Day)Phone Number (Evening)I. Type of Project* Current Funding Deferred Funding II. Proposed Charitable PurposeThe religious, educational, scientific or other charitable purposes of the proposed project are (please include specific names and addresses of qualified tax exempt charitable organizations to which donations may be intended, as well as non-qualified organizations or causes.) If appropriate, indicate the percentage of distribution to each charity. Attach a seperate sheet if necessary.Please include in the following format: (Name of Charity, Address Specific Program (if any), * Percent of each year's distribution for this charity) *Total Must Equal 100%Please include in the following format: (Name of Charity, Address Specific Program (if any), * Percent of each year's distribution for this charity) *Total Must Equal 100% III. Successor ManagementWhen the original donor(s) passes away, or if the project is funded upon the death of the original donor(s), U.S.F.F. will name someone to succeed the original donor(s) as advisor to the project. Your advice below will be helpful in accomplishing this.A. In the event of your death, or disability, whom do you nominate as advisor for this project?Name First Last Relationship: Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberB. In the event the successor manager you have suggested cannot, for any reason, fulfill his / her responsibilities, whom would you recommend as the alternate project advisor? Name First Last Relationship: Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberNOTE: The successor project advisor may select an advisory board to assist with project management. However, U.S.F.F. will ultimately rely on one successor project advisor for advice relative to the project and his / her signature is required on all distribution request forms. In order to assist us in understanding your successor's role in advisement of your charitable project, please complete the Charitable Project Successor Advisement Form. Method for Funding Please supply the following information as appropriate:1. Initial Cash Funding: 2. Charitable Remainder Trust: Unitrust Annuity Trust Initial Funding Value: Current Value if Different: Payout Rate of Trust: Birth Date(s) for Income Beneficiary(s): 3. Life Insurance or Annuity: Face Value of Policy: Insurance Company Name: Policy Number: Mailing Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agent's Name: First Last Agent's Phone Number:4. Bequest: Estimated Present Value of Benefit:* 5. Non-Cash Property: List asset(s) you are considering gifting, including type of asset, location (if appropriate), cost basis, fair market value (if known), etc. (i.e.) Appreciated Stock, Real Estate, or Family Limited Partnership: AGREEMENT STATEMENT By completing and signing this application, I certify that I understand the nature of donor-advised fund and will conduct activities which satisfy the requirements of the Internal Revenue Code. I will abide by the policies and conditions set forth by the US Family Foundation, Inc., which in some instances, exceed government requirements. I understand that in order to qualify as a deductible contribution for income tax purposes, the ownership and custody of my donated funds and property will be fully relinquished to the US Family Foundation, Inc. Further, I understand that the foregoing information is advisory only and that ultimate decisions an control relative to each of these issues are the responsibility of US Family Foundation, Inc. The foregoing advice does accurately represent my desires for my US Family Foundation Project.Electronic Signature:* First Last Date:* Month Day Year Electronic Signature: First Last Date: Month Day Year