Event:__________________________________________________________

Date:___________________________________________________________

Name(s) of Donating Party:   _________________________________________
 
                                                  _________________________________________
 
                                                 __________________________________________
Address (if available):
                                                  _________________________________________
 
                                                 __________________________________________

Phone No. (if available):        __________________________________________

                                                 __________________________________________

Hours Donated:                      __________________________________________

Mileage Donated:                  __________________________________________
(Total distance-“to-and-from”)

Description of Donation:       __________________________________________

 _______________________________________________________________

Items Donated & Monetary Value:
(continue on back of form-if needed)
    _________________________________________________    _______

    _________________________________________________    _______

    _________________________________________________    _______

    _________________________________________________    _______

     _________________________________________________    _______

    _________________________________________________    _______