Medical Aid Donation Accounting Statement

This is an accounting statement for medical aid provided by the donor as a receipt for tax deduction purposes. The services listed and valued within is based on the fair market value of such items and is to be used for non-profit rescue and development purposes.

I hereby attest that the following Accounting Statement is complete and accurate to the best of my knowledge. As the donor or acting representative of the donor I acknowledge the receipt of this accounting statement and have agreed to the donation of all things listed.

Donor/Supervisor Signature_____________________________________Date______________

I hereby attest that the following Accounting Statement is complete and accurate to the best of my knowledge. As representative of _________________________________rescue I understand this Donation Accounting Statement and the donors right to revision or rescission within the given 72 hour period.

Rescue Representative Signature____________________________________Date___________