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Mail in Donation Form

Instructions: 
• Fill in form, then use the link at the bottom of the page to print completed form. 
• Checks should be made payable to MCCF.
• If you are contributing to a specific fund, write fund name on Memo line of check.
• If your employer will Match your gift, please enclose completed form.

Mail to:
Middlesex County Community Foundation
211 South Main Street, Middletown, CT 06457

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I would like to add to:    Live Local Give Local / Unrestricted Grantmaking   

Essex Basketball Center & Gateway Project    Unrestricted Use   

Avery's Fund    President's Discretionary Fund    Women & Girls   

Ryan's Circle of Giving Fund    Arts Fund / Swaim Arts Fund   

Animals: Respect and Friendship Fund    Operations   

Other  

(Please write fund name on Memo line of check.)

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Amount Enclosed:

  $2,500    $1,000    $500    $250    $100    $50    $25  

                   (Checks should be made payable to MCCF.)

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Credit card donations:    Visa         MasterCard    

Card No.:   Exp. date:

Print name as it appears on card:

Signature of cardholder:  ________________________________________

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Matching Gift: My employer will match my gift to the Community Foundation.

                          Form is enclosed            Information to follow

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Contributions to Middlesex County Community Foundation
are tax deductible to the full extent of the law.
Please fill in the information below for your tax receipt.

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Name:

Business/Organization:

Address:

City, State, Zip:

Telephone:

Email address:

             Send me email updates             I/We wish to remain anonymous

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  This donation is in memory of:

  This donation is in honor of:

    Relationship to you (if any):

Please provide a name and address if you would like us to notify the
family / honoree of this gift. (Amount is not included.)

Name:

Address:

City, State, Zip:

    Relationship:

Click to Print This Page

Thank you for your support!
Middlesex County Community Foundation does not sell or share your information.

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