Family & Youth Services Bureau

A Gift to Porter County's Youth

Please accept my enclosed gift of $ to the FYSB.

Please accept my pledge of $ to the FYSB.

Please send reminders as specified

This is a personal donation.

This is a corporate donation.

Name(s)

(as you would like it to appear in printed materials)

Company Name (if applicable

Address

City/State/Zip

Telephone (home) (work)

Donation in memory/honor of (Name)

Send Acknowledgement to

I have enclosed a check for $ (Please make payable to FYSB)

Signature _______________________________________________________________

Thank you for your generosity!

Family & Youth Services Bureau
253 W. Lincolnway
Valparaiso, IN 46383

219-464-9582
Fax: 219-462-4195
www.fysb.org

Family & Youth Services Bureau

Receipt for donation

Amount $
Date

All gifts are tax deductible in the extent that no goods or services are provided in return.

FYSB is:
a 501(d) (3) tax exempt organization
a United Way of Porter County member agency
an "affiliate fund" of the Porter County Community Fondation