Missionary Oblates of Mary Immaculate
Charitable Gift Annuity Application
1. Type of Annuity
One-Life Gift Annuity
Payments are made to one person for life. (Complete #2, 3, & 4)
Two-Life Gift Annuity
Payments are made to one person, generally the owner of the annuity. At the owner's death, payments are made to the survivor for life.
(Complete #2, 3, 4, & 5)
Joint-Life Gift Annuity
Payments are made to two persons jointly. Upon the death of one annuitant, payments continue to the survivor for life. (Complete #2, 3, 4, & 5)
2. Amount of Annuity
$______________ (minimum $1000) (Checks payable to: Missionary Oblates of Mary Immaculate )
Cash
Stocks
Cost basis of stock $ ____________________
Credit Card
VISA
Discover
American Express
Credit Card No: ______ ______ ______ _____
Exp. Date: _____/_____
CID #: ______
3. Payment Schedule
Annually
Seminannually
Quarterly ($5,000 +)
Monthly ($10,000 +)
4. One-Life Annunity Information
Mr. Mrs. Ms. Miss
Full Name: __________________________________________________
Address: ____________________________________________________
City: ____________________
State: _________
Zip: __________
E-Mail: ______________________
Date of Birth: _____/_____/______
SS#: _____-_____-_____
Phone: _____-_____-______
  (minimum age 50)      
Signature: __________________________________________________
Date: _____/_____/_____
5. Joint-Life/Two-Life Annuity Information
Mr. Mrs. Ms. Miss
Full Name: __________________________________________________
Relationship to above:
_________________________
(spouse, brother, etc)
Address: ____________________________________________________
City: ____________________
State: _________
Zip: __________
E-Mail: __________________
Date of Birth: _____/_____/______ SS#: _____-_____-_____ Phone: _____-_____-______
  (minimum age 50)      
Signature: __________________________________________________
Date: _____/_____/_____
Mail to:
The Office of Charitable Gifts  
  PO Box 730  
  Belleville, IL 62222-9978