"Bridging the Gap" Securities Gift Form

Thank you for considering making a gift to the "Bridging the Gap" campaign through securities (mutual funds, stocks or bonds).

You will need to share the following information with your brokerage to make the transfer of securities:

Transfer Agent: Reliance Trust Company
c/o FNB Wealth Management 74-1036-01-6
DTC Number: 5409
Account Name: St. Paul Homes Gen Inv-FNB
Account Number: 50-63-0003-09-3

Before initiating the transfer, please complete the form below to notify the Charitable Giving Office, or contact Dawn Hartman, Director of Strategic Giving, at 724-589-4611.

Fields marked with are required.

First Name

Last Name

Street Address

City

State

Zip Code

Phone

Gift Amount

This is a tribute gift.

Tribute Type

In Honor of

In Memory of

Tribute Name

Brokerage Name

Broker's Name

Phone

Name of Securities

Number of Shares

Donor Recognition

Gifts of $5,000 or more will be recognized on a donor recognition plaque for the campaign. Please write exactly how you would like the recognition to appear on the plaque.

Example: In Memory of John Smith from his loving family

Gifts of $3,000 will be recognized on a paver stone along the trail. Please write exactly what you want the message to be on your stone.

Example: In Memory of Jane Brown for her loving family

No recognition please. I want my gift to be anonymous.

"Bridging the Gap" Securities Gift Form

Donor Recognition

Bridging the Gap Campaign