CONFIDENTIAL REPLY FORM . Please return your completed form to
St. Luke’s Episcopal Church
CONFIDENTIAL REPLY FORM ___ I have named St. Luke’s Episcopal Church as a beneficiary in my Will or in a Codicil to my Will. ___ I have designated St. Luke’s Episcopal Church as a beneficiary on a life insurance policy on my life. The carrier is . ___ I have designated St. Luke’s Episcopal Church as a beneficiary to a qualified retirement plan through . ___ I have established a Charitable Remainder Trust which names St. Luke’s Episcopal Church as the final beneficiary. This action was transacted through . ___ I have provided for St. Luke’s Episcopal Church in a manner different from above.
The clergy and the lay leadership of St. Luke’s Episcopal Church are grateful for your thoughtful provisions which reflect a forward-looking view of the church’s future. They would like to provide appropriate recognition for your generosity and seek your permission to include your name as a member of the Good Shepherd Society in lists of donors and on a plaque to be mounted in a visible spot in the church. I/We: ___ do give permission to have my/our name(s) so included. ___ do not give permission to have my/our name(s) so included. For publication purposes, please list my/our name(s) as:
Date:
Signature:
Printed Name: Printed Address:
Phone:
Email Address:
Please return your completed form to: Mark Simmons • Good Shepherd Society • St. Luke’s Episcopal Church • Atlanta, GA 30308-3228 F:\001. ST. LUKE'S\ETC\New Confidential Reply Form - GSS - Blank - 2012-05-21 (2).doc
CONFIDENTIAL REPLY FORM ___ I have named St. Luke’s Episcopal Church as a beneficiary in my Will or in a Codicil to my Will. ___ I have designated St. Luke’s Episcopal Church as a beneficiary on a life insurance policy on my life. The carrier is . ___ I have designated St. Luke’s Episcopal Church as a beneficiary to a qualified retirement plan through . ___ I have established a Charitable Remainder Trust which names St. Luke’s Episcopal Church as the final beneficiary. This action was transacted through . ___ I have provided for St. Luke’s Episcopal Church in a manner different from above.
The clergy and the lay leadership of St. Luke’s Episcopal Church are grateful for your thoughtful provisions which reflect a forward-looking view of the church’s future. They would like to provide appropriate recognition for your generosity and seek your permission to include your name as a member of the Good Shepherd Society in lists of donors and on a plaque to be mounted in a visible spot in the church. I/We: ___ do give permission to have my/our name(s) so included. ___ do not give permission to have my/our name(s) so included. For publication purposes, please list my/our name(s) as:
Date:
Signature:
Printed Name: Printed Address:
Phone:
Email Address:
Please return your completed form to: Mark Simmons • Good Shepherd Society • St. Luke’s Episcopal Church • Atlanta, GA 30308-3228 F:\001. ST. LUKE'S\ETC\New Confidential Reply Form - GSS - Blank - 2012-05-21 (2).doc
