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United Samaritans Foundation.

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In Memory Of_______
In Honor Of_______
 Gift Given For:

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Please Send Acknowledgement to:

_____Wedding Anniversary
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_____Mother's Day
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DONOR INFORMATION

Enclosed is my gift of $_____________

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  Please make your check payable to UNITED SAMARITANS FOUNDATION
and mail this form with your contribution to:
United Samaritans Foundation - 220 South Broadway - Turlock, CA 95380
 

YOUR GIFT IS TAX DEDUCTIBLE