Declaration of Intent | Spencer-Lowry Legacy Society

Yes, I/We are committed to providing a planned gift to Lenawee Humane Society and request that you accept my/our membership into the Spencer-Lowry Legacy Society.

This form is intended to assist Lenawee Humane Society in carrying out your wishes. This is a statement of intent and is not intended to be a legally binding commitment.

Date

First Name

Add spouse/partner

Last Name

DOB

Address

City

State

Zip

Phone

I/We have made a provision to support LHS through my/our:

Will

Life Insurance Policy

Retirement Plan Assets

Trust Agreement

Other (please specify)

My/our documents were executed on:

Attorney/Advisor's Name:

Executor's Name:

Attorney/Advisor's Phone:

Executor's Phone:

I give permission to include my name on the list of Spencer-Lowry Legacy Society members:

No Yes

I/We wish to remain anonymous:

No Yes

I/We would like information on LHS's Spencer-Lowry Guardianship Program:

No Yes

How do you prefer to be contacted?

I/we permit LHS to acknowledge my/our commitment, although the terms of this gift shall remain confidential to the extent provided by law.