Property Donation Form

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Real Estate Donations
C/O Restoration America
613 West Main Street
West Dundee, IL 60118

1-800-237-8890 Office
1-847-551-1049 FAX

Property Donation Form

Please complete the following information so we can contact you.

Owner's Name

Your Name (if different)

Your Telephone

Your Email

Type of Property

Address/Location

City

State

Owner's Interest
FullPartial

Free and Clear
Encumbered (Loan Balance)

Owner's value Source

Land value Improvements value Age

Date acquired (mm/dd/yy) Adjusted cost basis

How acquired Name on title (all owners of record)

Is property listed or been listed recently?
Yes No If yes, name of listing Broker

Designated recipient charity

Current property expenses
Taxes

Insurance
Maintenance

Utilities
Other

If Rented
Gross income Operating expense Net cash flow

Method of gift

Birth date and sex of retained interest beneficiaries (mm/dd/yy)

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