Gift of Stock and Securities

Gift of Securities Transfer Notification

Designated Camp Allen Gifts through The Episcopal Diocese of Texas
Thank you for considering a gift of securities to Camp Allen. Gifts are received through the Protestant Episcopal Church Council of the Diocese of Texas (“The Church Corporation”), a Texas 501(c)(3) tax-exempt organization, and are designated for Camp Allen.

Please complete this form before initiating your transfer. It helps Camp Allen and the Episcopal Diocese of Texas identify your gift promptly and ensure it is credited according to your wishes. This form does not initiate the transfer; please also instruct your broker using the delivery information below. The delivery instructions are also included in your confirmation email for easy reference.

Transfer Instructions
For electronic transfers, please have your broker deliver securities by DTC, free of payment (F.O.P.), to:

Receiving account: Episcopal Diocese of Texas
Account number: U7716754
Custodian: Interactive Brokers, LLC
DTC number: 0534
Delivery method: F.O.P. / free through DTC

For gifts of physical stock certificates, please contact the Diocese before mailing. Certificates should be sent by registered mail to: David N. Fisher, Episcopal Diocese of Texas, 1225 Texas Avenue, Houston, TX 77002-3504. If certificates are registered in your name, please send a signed stock power under separate cover.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Camp Allen Gift Designation

Other
Name of Security
Ticker Symbol
Number of Shares
Estimated Value
Expected Transfer Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Delivering Brokerage Firm
Last 4 Digits of Delivering Brokerage Account
For privacy, please only provide the last 4 digits.
Delivery Method

Other
Delivering Broker’s DTC Number
Broker Contact Name
optional
Broker Contact Email
optional
Additional Notes or Instructions
I understand that this form is a notification only and that I must separately instruct my broker to complete the transfer.
Should be Empty:

Gift of Securities Transfer Notification