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       Please print this form and mail to the address below.

Memorial / Honorarium Donations for Homes for Hearts, Incorporated

Donations to be made to:

Homes for Hearts, Incorporated

P.O. Box 3752

Morganton , N.C. 28680-3752

1-828-430-3140  www.homesforhearts.org

Name:  __________________________________________________________  

Address:  ________________________________________________________  

Phone Number:  ___________________________________________________  

Donation Amount:  $__________________  

In Honor / Memory of: _______________________________________________
  (circle one)

 ____  Check here if you wish to receive a tax deductible donation receipt

Please designate how you wish money to be used:

__ Christmas gifts for foster children

__ Andrea Jacks Memorial Scholarship Fund

__ Prom project of foster care youth

__ Use as needed for children in foster care

__ Birthday fund

__ Other, please specify _______________________________________