In-kind Receipt Form : In-kind Receipt Form : Catholic Social Services of Southern Nebraska

Donor Name (Required)

Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Phone

Phone type

This is a request for a:

Date of Donation (Required)

Place of Donation (Required)

Items donated (Required)

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Additional notes and comments (this will NOT be on your emailed receipt)

Additional Notes/Comments

After clicking the submit form, you will receive an email to use for tax purposes.

Item Donation