Stock Transfer Form

Please follow these steps to notify Jacob’s Well of your donation:

1. Contact your broker to initiate the transfer of your securities to Jacob’s Well (see information in the Electronic Transfer Information section below).

2. Please complete this form at the time of the gift transfer so we can accurately identify, allocate, and acknowledge your gift. Send this form to:

Jacob’s Well

Katy Kennedy

3751 17th Avenue South

Minneapolis, MN 55407

Phone: 612-822-0300 or email the information to

Your name and address:

______

______

______

Securities Gifted:

Number of shares _____ Name of securities ______

Date of transfer______

Special Instructions/designation ______

Transferring Broker ______Company______Phone ______

Electronic Transfer Information:

Jacob’s Well Brokerage Account

Wells Fargo Advisors

DTC #: 0141Account #: 5530-8491

If you are sending a Letter of Intent (LOI) to your broker, please list your gift as a charitable donation to Jacob’s Well, a non-profit corporation (Fed Tax ID 16-1779569), and use the mailing address, phone number, and fax listed below. Here is an example for your use.

Wells Fargo Advisors

Attn: MAC H0006-094

1 North Jefferson Avenue

St. Louis, MO 63103

Phone = 1-800-872-3377

Fax = 1-800-433-0738

Stock Transfer Form – cont’d

Valuation

The value of your gift will be the average of the high and the low trading prices on the date we receive your gift. The date of gift is the day Jacob’s Well assumes ownership of the security.

Benefits

Your gift may provide you with federal and state income tax benefits:

  • If you itemize deductions on your federal income tax return, you may be able to deduct your contribution to Jacob’s Well from your adjusted gross income. In addition, gifts of appreciated property avoid long term capital gains tax. Check with your tax advisor for deduction and capital gains tax requirements and limitations for your situation.
  • Your state may also allow a credit or deduction so you should ask your tax advisor.

If you have a question for Wells Fargo Advisors, please contact Jason Matthews at 1-855-229-1726 x192586 or the customer service line at 1-800-872-3377.