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Estate Intention Form

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  • Estate Intention Form


(*) denotes required information.

* Name:

* Address:

* City:

* State:

* Zip Code:

I have made the following provision for Keystone College in my estate plans:

 Residuary Bequest

Keystone College's percentage of residue estate %
Estimated value of bequest $

Outright bequest in my will $


Bequest subject to conditions (please describe)



Trust arrangement with Keystone College as a beneficiary

Present size of trust corpus $
Keystone College's percentage of remainder interest   %
Trustee (if other than Keystone College) 

Life Insurance Policy

Policy Face Amount $
Policy Number #
Name of Insurance Company
Type of Policy
Keystone College's interest subject to conditions (please describe):
Other Planned Gift (please describe):
If restricted, (please describe):

Would you like to be listed in the Evergreen Society directories?

Yes, please list my name (and/or my spouse’s name) in all Evergreen Society directories
List name in the following manner 
No, I prefer that you do not include my name in the published list of Evergreen Society.