Date: _________________________

I suggest distribution(s) from_________________________________________________________
                                                            (name of fund)
to the following organization(s) in the amount(s) listed:

Organization (and contact person if known)          Special Instructions          Amount

I acknowledge that the above suggestions do not represent the payment of any pledge or other financial obligation, nor does the undersigned expect any personal benefit from this charitable distribution.

___________________________________________
Signature

___________________________________________
Phone                                                            Date

Should the Board of Trustees have any questions about your suggestion(s), you will be contacted by a member of the Community Foundation of Greater Jackson staff.

Please return this form to the Community Foundation of Greater Jackson. A notification letter and check will be sent to the recipient(s) following review and approval of your request by the Board of Trustees. You will be notified after the distributions are made.