Stock Transfer Form

Today's Date(Required)

Follow Up Date

Donor Information

Stockholder's Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Stock Information

# Shares(Required)

Date Xfer(Required)

Stock(Required)

Date Rec'd(Required)

Cost/ Share $(Required)

Approx. $(Required)

Commission $(Required)

Donation $(Required)

Stock Held At

Brokerage Firm(Required)

Broker's Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Comments

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Donor Instructions

• Contact broker or financial advisor and advise the stock and number of shares to be transferred to Catholic Charities of NE Kansas. Donor gives his/her broker the name of our broker, brokerage, account number and DTC.

Catholic Charities Instructions

• Instruct donor’s broker to electronically transfer stock to our Catholic Charities account: ❑ UBS, CC Acct #JK21689-42 via DTC 0221 Sam Sabaugh, 913-345-3270; Amy Brooks: 913-345-3254; [email protected] (emailed on___________________)

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Catholic Charities of Northeast Kansas offers 30+ programs across 21 counties.

We serve our neighbors, of all faiths, through Help, Hope & Hospitality.

“Whatever you did for one of these least brothers of mine, you did for me.”