Please fill out completely and leave with all items donated to Moving in the Spirit.

Description of item:

Date Received:

Name of Donors:

Address:

City, State, Zip:

Phone:

Email:

Value assigned: receipt attachedfair market value

Method used to assign value:

Purpose of the donation:

Donor signature:

Date:

Person receiving the item:

Please attach a copy of the receipt, invoice or price tag if available