MEMORIAL OR ALTERNATE GIFT TO THE SUNSET HOUSE

Please accept the enclosed check for $ ________ which I designate as a memorial or alternate gift in the name of _________________________.

Please notify his/her family:    ________________________________
                                               _________________________________
                                               ________________________________
                                                                                                   (address)

that I made this contribution    __________________________________
                                                                               (name of gift giver)
                                               ___________________________________
                                               ____________________________________
                                                                                 (address) 

This gift is for Memorial  _______
                       Christmas _______
                       Birthday   _______
                       Other       _______

Please make your check payable to: Sunset House, Inc.
and mail to: 3746 St. Paul Boulevard
                     Rochester, NY   14617

Please print a copy of this form to enclose with your check.
This donation is tax deductible.

Thank you very much for your generous gift.