Gift Aid Declaration

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COUNTIES
30 Haynes Road
WESTBURY
BA13 3HD

TITLE (*Mr/Mrs/Miss/Ms/other).......................................... * delete as appropriate

SURNAME...........................................................................................................................

FORENAME(S)...................................................................................................................

FULL ADDRESS.................................................................................................................

..............................................................................................................................................

................................................................................(POSTCODE) ......................................

I am a taxpayer and I want COUNTIES to reclaim tax on all donations I have made
since 6 April 2000 and all donations I make hereafter.

I confirm that all gift are for the COUNTIES General Fund, unless I expess a wish for it to be used in a particular way, however I understand that this can not be legally binding on COUNTIES.

 

Signed ................................................................................. Date .......................................
Notes: 1. Remember to notify us if you no longer pay an amount of income tax or capital gains tax equal to the tax we reclaim on your donation.
2. You are entitled to notify us of the cancellation of this declaration at any time.