Mennonite Home Communities - IRA Transfer Form

IRA Transfer Form

Sample Letter of Instruction from Donor to
IRA Plan Provider for IRA Rollover Gifts



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 Protecting Americans from Tax Hikes of 2015, section 112.

□ Please issue a check in the amount of $ payable to Mennonite Home Communities ( a 501 (c)(3) charity, EIN 23-1413689) at the following address:

Mennonite Home Communities
Greg Pierce, Director of Development
2001 Harrisburg Pike
Lancaster, PA 17601

In your transmittal to the charity, please state my name and address as the donor of record in connection with this transfer, and copy me on your transmittal. It is my intention to have this transfer qualify during the 2017 tax year.

If you have any questions or concerns regarding this request, I can be reached at [PHONE AND EMAIL ADDRESSES].

Thank you for your prompt attention to and assistance with this matter.

Sincerely yours,


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  • Woodcrest Villa
    Residential Campus

    2001 Harrisburg Pike
    Lancaster, PA 17601
    Ph: 717.390.4100

    map & directions

  • Mennonite Home
    Care Campus

    1520 Harrisburg Pike
    Lancaster, PA 17601
    Ph: 717.393.1301

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