Total Donation: $0.00

Child Start, Inc. Head Start

Serving Children and Families in: Missoula, Mineral, Granite, Powell, and Sanders Counties

1001 Worden, Missoula, MT 59802 | Phone (406) 728-5460

IN-KIND DONATION AFFIRMATION

Child Start, Inc. hereby confirms the following in-kind donation:

Donor Information

Type:

Individual/Organization Making the Donation:

Address (Street, City, State, Zip):

Phone Number:

Volunteer Description/Donor Category:

Donation Details

Date of Affirmation/Entry:

Type of Donation:

Service Area:

Volunteer/Service Hours Details

Description of Hours Donated:

Clock In Time:

Clock Out Time:

Total Hours Donated:

Service Type Rate:

Calculated Fair Market Value of Hours ($):

Supply/Equipment/Space Details

Description of Donation (Supply, Equipment, Space):

Fair Market Value ($):

Total Value

TOTAL DOLLAR VALUE OF DONATION ($):

Verification

Verifier Type:

I certify that the above description and value of donated items and/or services is accurate and true to the best of my knowledge.

Name:

Title:

Date of Verification:

Digital Signature:

Donor Receipt

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