Bequest Intent Form

This document is a record of your intention to leave a gift to the University of Utah through your estate plan. This document does not bind you or your estate, and your gift will be treated as confidential. However, it does allow us to plan responsibly for the future and encourage other alumni and friends to consider the University of Utah in their estate plans. We recognize that gifts may change over time, and we hope that you will notify us of any changes.

Thank you for your generosity to the University of Utah.

First Name

Last Name

Spouse or Partner First Name

Spouse or Partner Last Name

Email Type

PersonalBusiness

Date of Birth

Address

Address Line 1

Address Line 2

City

State/Province

Zip/Postal

Country

Spouse/Partner shares address

My spouse/partner shares the address listed above with me.

Gift Information

A gift has been provided for the benefit of the University of Utah through the following:

Will	Retirement Plan Assets
Real Estate	Living Trust
Life Insurance Policy	Charitable Remainder Trust
Other

Please describe the “Other” gift type.

The current estimated face value of the gift described above:

The gift described above is designated to benefit the following College, Program, Purpose and/or Fund*:

*If you do not designate a desired College, Program, Purpose and/or Fund
for your gift, please note that your gift will be used to support the greatest needs of the University of Utah as determined by the President.

Through the Dr. John R. Park Legacy Society, the University of Utah extends its warm appreciation to individuals who make known their thoughtful gift intentions through a legacy gift. The Park Legacy Society is administered through the Advancement Office. All donors who notify the University of Utah of a legacy gift are automatically enrolled in the Park Legacy Society unless they prefer to opt-out.

If you have questions regarding the Park Legacy Society or this form, please contact any member of the Legacy Giving team at 801-581-6824 or legacygiving@utah.edu.

Our mailing address is 332 South 1400 East, Suite 160, Salt Lake City, UT 84112.

Please let us know your privacy preferences:

I/we wish to be acknowledged in university publications, recognizing that it may inspire others to give.I/we prefer to remain anonymous for publicity purposes.

I hereby authorize the University of Utah and its officers, agents, employees, successors, licensees, and assigns to take photos and recordings of me and to and use my image, likeness, and appearance without compensation to me, for any educational, nonprofit, institutional, scientific, or informational purpose. This consent is completely voluntary.

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Bequest Intent Form

Bequest Intent Form