IRA Qualified Charitable Distribution Request Letter

[Donor Name]
[Donor Address]
[City, State ZIP]
[Phone]
[Email]

[Date]

[IRA Custodian Name]
[Custodian Address]
[City, State ZIP]

Re: Request for Qualified Charitable Distribution (QCD)
Account Number: [IRA Account Number]

Dear Sir or Madam,

Please accept this letter as my formal request to make a Qualified Charitable Distribution (QCD) from my Individual Retirement Account listed above. I am requesting a direct charitable distribution in the amount of $__________ to the following qualified 501(c)(3) organization:

Life Choices Pregnancy Center / 7B Care Clinic
35 Litehouse Drive
Sandpoint, ID 83864
Tax ID (EIN): 75-2989202
Phone: 208-263-7621

Please make the check payable to Life Choices Pregnancy Center and mail it directly to the organization at the address above.
Please include my name and mailing address with the distribution so the charity may properly acknowledge my gift.

This distribution is intended to qualify as a QCD under Internal Revenue Code Section 408(d)(8) for the current tax year. It is also intended to count toward my Required Minimum Distribution (RMD).

If you require additional information or forms, please contact me at the number listed above.

Thank you for your assistance.

Sincerely,
[Donor Signature]
[Donor Printed Name]