Giving Statement Request Form

When completing this form you are requesting a copy of your giving statement from the previous year.

Giving Statement Request (all fields are required)

First Name

Middle Initial

Last Name

Are you a member? Are you a member? Yes No

Payroll Deduction: Payroll Deduction: Yes No

Email Address

Telephone / Contact Number

Street Address

Address Line 2

City

State

Zip Code

How would you like to receive your giving statement? How would you like to receive your giving statement? By postal mail By email

Consent Consent I certify that I am the member completing this form and give of From the Heart of Los Angeles permission to provide my giving statement based the information provided above.

*Your privacy is important to us. Your information will not be shared, and you will not receive solicitations from us.



1401 West Spring Street
Long Beach, CA 90810