Senior Services

4700 Dublin Ave.   ~  Midland, Michigan  48642  ~  989-633-3700

Midland County Council on Aging

Making Life Easier for Older Adults

Donation Form
Chose “File” then “Print” from your browser toolbar to print form.

Donor Name(s) ____________________________________________________

Address __________________________________________________________ 

City ____________________________ State _____ Zip Code _______________

Daytime Phone ____________________________________________________

Email ____________________________________________________________

Amount of Donation $__________________________.  Your gift is tax deductible.

If you know of a specific program you want your gift designated to, please indicate:

_________________________________________________________________

If Applicable, Check One     _____In Memory of      _____In Honor of:

_________________________________________________________________

_____ Remain Anonymous

_____ Send Acknowledgement to:

Name ____________________________________________________________

Address __________________________________________________________ 

City ____________________________ State _____ Zip Code _______________

 

Send completed form with check made payable to “Senior Services” to:

Senior Services
4700 Dublin Ave.
Midland, MI  48642

Senior Services gratefully acknowledges your gift and support.