Join the Clock Tower Society

Intent*

Yes, it is my/our intent to support the higher education and community service missions of Missouri Western State University. I/we have included a gift for the benefit of Missouri Western State University in my/our estate plan. All legal documents required to activate this planned gift have been signed and properly executed. The information provided below describes my/our gift. It is understood that, unless I notify the Foundation that I do not wish to be listed, I will be included on the roster of Clock Tower Society members that will be published in University publications and public reports.

Donor 1 Name*

First Last

Date of Birth*

Donor 2 Name

First Last

Date of Birth

Contact Information

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Roster Listing

Anonymous Listing

I/we wish to be listed as Anonymous

Name(s) as it is to be shown on the roster

My/our affiliation with Missouri Western is as follows*

(please check all that apply)

Interested friend of Missouri Western
Missouri Western/St. Joseph Junior College alumnus
Current or former Missouri Western employee
Parent of student or alumnus
Other

Other*

You have indicated your relationship with Missouri Western as "Other." Please specify your relationship.

Gift Information

Gift Type*

Please check all that apply.

Bequest in a Will or Revocable Trust
Charitable Remainder Trust
Life Insurance Benefit
Retirement Plan Benefit
Retained Life Estate
Other

Other*

You have indicated your gift type as "Other." Please specify your gift type.

Gift Value

Please specify the estimated value of your gift.

Gift Designation*

Designated Gift*

You have indicated you would like to designate where your gift is used. Please specify for what purpose you would like your gift to be used.

About Missouri Western State University Foundation

The Missouri Western State University Foundation, Inc. is an IRS approved 501(c)(3) charitable organization, which means that contributions qualify for the charitable deduction on your Federal Income Tax Return. It is recommended that bequests/gifts to benefit Missouri Western State University be made payable to the Missouri Western State University Foundation, Inc.

Beneficiary*

Other Beneficiary*

You have indicated your beneficiary as "Other." Please specify your beneficiary.

Designated Contacts (Optional)

General Contact

After your bequest has been received by the Missouri Western State University Foundation, who should we contact if there is a question regarding your bequest/gift?

Executor/Personal Representative of Your Estate

Attorney

Accountant

Life Insurance Agent

Other

Charitable Beneficiaries*

Are there other charitable beneficiaries of your estate/financial plan?

Other Charitable Beneficiaries*

You have indicated there are other charitable beneficiaries in your estate/financial plan. Please specify the other beneficiaries in your plan.

The information you have provided will be treated as confidential. Thank you for your generosity in including Western in your estate plan and for providing this data.