Date
Name of IRA administrator
Address
City, State Zip Code

Re: Request for Qualified Charitable Distribution from Individual Retirement Account

Dear IRA administrator:

Please accept this letter as my request to make a direct qualified charitable distribution from my individual retirement account number [insert number here] as provided for by the Consolidated Appropriations Act of 2016 and Sec. 408(d)(8) of the Internal Revenue Code of 1986.

Please issue a check in the amount of [insert dollar amount], payable to the Divided Sky Foundation Corporation, and mail it to:

Divided Sky Foundation
262 Fox Lane
Ludlow, VT
Federal Tax ID: 85-2784579

In your transmittal to the above-named charitable organization, please memorialize my name and address as the donor of record in connection with this transfer, and copy me on the transmittal at the address below. It is my intention to have this transfer qualify during this tax year. Therefore, it is imperative that this distribution be postmarked no later than December 31.

If you have any questions or concerns regarding this request, I can be reached at [insert telephone number and/or email address].

Thank you for your prompt attention to and assistance in this matter.

Sincerely,

Your name
Address
City, State, and Zip Code
Phone Number