Exhibit C
DONATION RECEIPT
Date Issued: ______________________
Donor Information
Name: __________________________________________
Address: ________________________________________
City/State/Zip: _________________________________
Donation Information
Date of Donation: ________________________________
Type of Donation (check one):
☐ Monetary Donation
☐ In-Kind Donation
Description of Donation:
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
Estimated Fair Market Value (for in-kind donations): $__________________ Amount (for monetary donations): $__________________
Purpose of Donation (if designated):
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
Acknowledgment Statement
The City of Richmond acknowledges receipt of the above-described donation. No goods or services were provided to the donor in exchange for this donation.
Director of Finance
Name: __________________________________________
Signature: ______________________________________
Date: ___________________________________________