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The Prudential Foundation Matching Gifts Program Complete this portion for direct giving by check New On-Line Giving Submit your request electronically at www. easymatch. com/Prudential For donations by credit card securities or life insurance please complete your request for Matching on-line at www. easymatch. com/prudential Section I To be completed by the donor Please print. Donor Instructions Complete Section 1 of this form one for each gift. Easymatch. com/Prudential For donations by credit card securities or life insurance please complete your request for Matching on-line at www. easymatch. com/prudential Section I To be completed by the donor Please print. Donor Instructions Complete Section 1 of this form one for each gift. Please print or type. Send the form and a copy of the program guidelines with your contribution to the recipient organization. Donor Recipient Organization Name Official Name Legacy Of A Hero The L/Cpl Chris Cosgrove III Foundation Inc. Employee ID or Retiree ID Address This ID number is found on each salary or pension payment stub Retirees use first two letters of last name birth month and day MMDD and last four digits in Social Security. I understand The Prudential Foundation s matching gift is for the unrestricted use of the organization and not for any specific purpose designated by me including the cancellation of any personal obligation. I verify that in return for this gift nor I or a member of my family have not received or will not receive any payment product service or anything else of value whatsoever. By signing this form I am certifying that the gift meets all of the requirements listed in the Guidelines. I understand that the maximum amount that will be matched is 5 000 per individual per calendar year for all methods of giving combined. Signature of Donor Date Foundation Matching Gifts Program please enclose a copy of your Internal Revenue Service 501 c 3 IRS determination letter and a brief description of your organization s primary mission statement or purpose. Org Address 12 Cypress Drive Website Addresses if any www. legacyofahero. org Gift Amount Telephone No. 973-734-1689 I certify that the above-indicated gift has been received and it will be used to support the primary objectives of the organization which is classified as a tax-exempt organization under section 501 c 3 of the U.S. Internal Revenue Code or is a governmental entity or agency and a this organization s mission and operations are broad and non-discriminatory or its activities address social needs or benefit underserved groups and communities b this is an eligible organization c the gift meets all of the requirements listed in the Guidelines d The Prudential Foundation received no goods services or other quid pro as defined in the relevant IRS rules and regulations. Proof of tax-exempt status is enclosed if this is the initial request to The Prudential Foundation Matching Gifts Program. Name Charlene A. Bowie Title President Signature Return this form to Prudential Matching Gifts Program P. O. Box 7184 Princeton NJ 08543-7184 Tel 1-800-554-7846. Forward form to the address printed below. Employer Identification Number EIN 26-0316723 Fax No. Organization Name Legacy Of A Hero The L/Cpl Chris Cosgrove III Foundation Inc. E-mail lcplcbcIII legacyofahero. org Address 12 Cypress Drive Website Addresses if any www. legacyofahero. org Gift Amount Telephone No. 973-734-1689 I certify that the above-indicated gift has been received and it will be used to support the primary objectives of the organization which is classified as a tax-exempt organization under section 501 c 3 of the U.S. Internal Revenue Code or is a governmental entity or agency and a this organization s mission and operations are broad and non-discriminatory or its activities address social needs or benefit underserved groups and communities b this is an eligible organization c the gift meets all of the requirements listed in the Guidelines d The Prudential Foundation received no goods services or other quid pro as defined in the relevant IRS rules and regulations. Proof of tax-exempt status is enclosed if this is the initial request to The Prudential Foundation Matching Gifts Program. Name Charlene A. Please print or type. Send the form and a copy of the program guidelines with your contribution to the recipient organization. Donor Recipient Organization Name Official Name Legacy Of A Hero The L/Cpl Chris Cosgrove III Foundation Inc. Employee ID or Retiree ID Address This ID number is found on each salary or pension payment stub Retirees use first two letters of last name birth month and day MMDD and last four digits in Social Security. Check One Employee Retiree Board Director Retired Board 12 Cypress Drive City State Zip Cedar Knolls NJ 07927-1558 Your Gift Gift Purpose if any Home Address Exact Date of Gift Tax-Deductible Gift Amount min 25 Home Telephone No. Gift Amount To Be Matched min 25 E-mail calendar year for all methods of giving combined. Work Address Work Telephone No. Donor Verification Signature Required This gift and its stated value which is made from my personal funds or property fully qualifies as a charitable donation for personal income tax purposes and is for the use of the above-named organization s. I understand The Prudential Foundation s matching gift is for the unrestricted use of the organization and not for any specific purpose designated by me including the cancellation of any personal obligation. I verify that in return for this gift nor I or a member of my family have not received or will not receive any payment product service or anything else of value whatsoever. I understand that the maximum amount that will be matched is 5 000 per individual per calendar year for all methods of giving combined. Signature of Donor Date Foundation Matching Gifts Program please enclose a copy of your Internal Revenue Service 501 c 3 IRS determination letter and a brief description of your organization s primary mission statement or purpose. Forward form to the address printed below. Employer Identification Number EIN 26-0316723 Fax No. Organization Name Legacy Of A Hero The L/Cpl Chris Cosgrove III Foundation Inc. E-mail lcplcbcIII legacyofahero. org Address 12 Cypress Drive Website Addresses if any www. legacyofahero. org Gift Amount Telephone No. 973-734-1689 I certify that the above-indicated gift has been received and it will be used to support the primary objectives of the organization which is classified as a tax-exempt organization under section 501 c 3 of the U.S. Internal Revenue Code or is a governmental entity or agency and a this organization s mission and operations are broad and non-discriminatory or its activities address social needs or benefit underserved groups and communities b this is an eligible organization c the gift meets all of the requirements listed in the Guidelines d The Prudential Foundation received no goods services or other quid pro as defined in the relevant IRS rules and regulations.