FINAL_MHF_GiinKindForm_
Donor Information Individual Organization or company
Donor name (as it should appear on receipt and in print)
Name of contact person (for organization or company)
Address City State ZIP
Phone Business phone Email
Signature Date Signature (optional) Date
Item Information (If valued at more than $5,000 a qualified appraisal is required. See below.)
Item name
Estimated fair market value of item $ ______________________________________ (Determined by donor)
Item description (Please specify color, size, material; aach detailed list for collections or multiple items)
I/we certify that I/we are the legal owners of the property being donated and this property is being donated to the University of
Minnesota without restrictions.
Gi Information (To be completed by the hospital/clinic accepting the gi)
Date gi was received Hospital/clinic
Purpose for which accepted
Signature and contact information of hospital/clinic staff member accepting the donation
Name Title
Phone Email
Signature Date
Per IRS regulations, any item you value over $500 requires IRS Form 8283; any item you value over $5,000 requires Form 8283 and a wrien appraisal.
Contributions of services and partial interest (e.g., use of beach condo) are not deductible as charitable contributions.
Should you have any questions on the above, please refer to www.irs.gov publications 526 and 561, and consult your tax advisor.
For more information:
University of Minnesota Foundation
200 Oak Street SE, Suite 500
Minneapolis, MN 55455-2010
612-626-0416 • s[email protected]
Gi-in-kind form
Verified by UMF development officer. (Initials)
