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N.O.A.H.
Nevada's Oldies
Are Helping
"Count Your Blessings" Appreciation Form
Print this page, fill in the form and mail it with your donation to
the address listed below
You do not need to be a member of NOAH to participate
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Taxable
Blessings
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Tax
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Amount
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| I
enjoy waking up every morning |
$.45 |
$____________
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| I have
a loving spouse |
$.50 |
$____________ |
| I have
a mother and father |
$.35 each
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$____________ |
| I have
___ sisters and brothers |
$.35 each |
$____________ |
| I have
___ children |
$.35 each |
$____________ |
| I have
___ grandchildren |
$.35 each |
$____________ |
| I have
___ great grandchildren |
$.35 each |
$____________ |
| I own
my own home/condo |
$.45 |
$____________ |
| I have
___ television sets |
$.40 each |
$____________ |
| I have
___ VCRS/DVD players |
$.40 each |
$____________ |
| I
have ___ radios, stereos and/or CD players |
$.30
each |
$____________ |
| I have
___ telephones |
$.30 each |
$____________ |
| I have
___ automobiles |
$.55 each |
$____________ |
| I have
a microwave oven |
$.50 |
$____________ |
| I have
an automatic dishwasher |
$.50 |
$____________ |
| I have
an automatic clothes washer and dryer |
$.50 each |
$____________ |
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TOTAL
BLESSINGS
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Line
(A)
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$
_________ |
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Deductible
Blessings
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Deduction
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Amount
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| I
am happy to be NOAH member |
$.10 |
$____________ |
| I attended
the NOAH meeting at Grand Assembly |
$.10 |
$____________ |
| I paid
my NOAH dues |
$.20 |
$____________ |
| I attend
at least one rainbow meeting a month |
$.20 |
$____________ |
| I am
serving on the Advisory Board of a local Assembly |
$.30 |
$____________ |
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TOTAL
DEDUCTIONS
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Line
(B)
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$
_________ |
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| Total
amount due (Line A minus Line B) |
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$_________ |
| Additional
donation to help Nevada Rainbow Girls |
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$_________ |
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Amount
Enclosed
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$_________ |
| Donation from: |
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| Name:____________________________________ |
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| Address:__________________________________ |
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| _________________________________________ |
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Please make Checks Payable
to: NOAH
Send to:
LeAnn Cox
NOAH Secretary/Treasurer
4320 Warren Way
Reno, Nevada 89509-5931
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