Please print this gift form, complete and mail with your donation information.
Your gift is tax-deductble to the extent allowed by law.

Mercy Tiffin Foundation
c/o Mercy Tiffin Hospital Development Office
45 St. Lawernce Drive
Tiffin, OH 44883

Enclosed is my/our gift of $
(make checks payable to Mercy Tiffin Foundation)

Your Name
Address
City State Zip

My Gift is:
in memory of
in honor of
on the occasion of

My Gift is for:
Endowment Fund
Community Appeal
Intensive Care Unit Fund
Unrestricted - use it where the need is greatest
Other

Please send acknowledgment to:
Name
Address
City State Zip

Please send me:
Additional gift envelopes
Information on endowing a fund
Information on giving through my will and estate plan
Other