Sample Letter from Donor to Plan Provider

January, 23 2014

Name of Plan Provider

City, State Zip

Re: Request for Direct Charitable Distribution from Individual Retirement Account

Dear Sir or Madam:

Please accept this letter as my request to make a direct charitable contribution from my Individual Retirement Account Number (insert account number) as provided by the American Taxpayer Relief Act of 2012. Please issue a check in the amount of $____________ payable to The Center for Creative Change at the following address:

Center for Creative Change
4115 Wisconsin Avenue, NW

Suite LL 10

Washington, DC 20024

Please  copy me on your transmittal. It is my intention to have this transfer qualify during the 2014 tax year. Therefore, it is imperative that this distribution be postmarked no later than December 31, 2014.

If you have any questions or concerns regarding this request, I can be reached at (telephone or e-mail address). Thank you for your prompt attention to and assistance with this matter.

Sincerely yours,

Name of Donor