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MEXICO APPEAL DONATIONS

Please print out this form

If you wish to donate by cheque or postal order please complete the following:

I enclose a Cheque / Postal Order for £……………………

Please make cheques payable to “Lytham St Annes Civic Society” and send to 29 Grange Rd., St.Annes, FY8 2BW. All donations will be acknowledged.

Name and Address for receipt:

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If you are a taxpayer, you can make your donation worth another 28% to the fund by filling in the following declaration. Higher rate taxpayers can also claim another 18% as relief on their tax return.

I wish to make my donation under the Gift Aid Scheme and confirm that this donation comes out of my current year taxable income

Title (Mr/Mrs/Miss/Other)……………………

Initials: ...………………………………………

Surname: ……………………………………………………...

Address: ………………………………………………………

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Signature: ………………………………………Date: ………………………………..