Gift of Stock Authorization Form

Gift of Stock: Authorization Form Thank you for your generous plans to make a gift of corporate stock to Peconic Community School. Please note that these electronic transfer instructions do not apply to gifts of mutual fund shares. Please call PCS (631-779-2934) to learn how to transfer shares of a mutual fund to Peconic Community School Once you have decided on the stock you will transfer to PCS, please complete and return the information below so that we can prepare an acknowledgment for tax purposes. The instructions below should be provided to your broker for the electronic transfer of stock. Please allow for sufficient processing time by your broker. Particularly at year-end, at least two weeks may be required. Information your brokerage firm will need: Peconic Community School’s Brokerage Account: Fidelity Wire Funds to: J.P. Morgan Chase, NY DTC Number: 0226 Account Name: Peconic Community School Account Number: Z48-705382 Phone number: 631-779-2934 PCS’s Tax ID: 46-0627620 Donor Information Donor Name: ___________________________________ Address: ___________________City:__________________ ST:________ ZIP:_____________ Daytime Phone: _________________________ Email: ____________________________ Brokerage Firm:_____________________________________ Broker’s Name: ____________________________________ Phone Number: ____________________________________ I have instructed my brokerage firm, _____________________________, to transfer to Peconic Community School, (# of shares/$ amount)_________________ of (Name)___________________________ stock to Peconic Community School. Signed: ________________________________

PECONIC COMMUNITY SCHOOL 269 Main Road | PO Box 273 | Aquebogue, NY 11931 631.779.2934 | www.peconiccommunityschool.org