Heritage Circle Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Alternate Phone NumberEmail* Date* Date Format: MM slash DD slash YYYY I have included or intend to include Larimer Humane Society in my estate plan by making the following provisions (check all that apply):* Larimer Humane Society is named in my will or living trust Larimer Humane Society is a beneficiary of my life insurance. Larimer Humane Society is a beneficiary of my retirement plan. I have made other provisions for Larimer Humane Society. (If this is chosen, please answer question below) If you chose that you have made other provisions for Larimer Humane Society, please describe them here:How would you like us to acknowledge your involvement with Heritage Circle?* I would prefer for my planned gift to remain private. Please do not include my name in Heritage Circle acknowledgement publications. I am glad to share my decision for a planned gift through a testimonial (written and/or video), to help promote involvement in the Heritage Circle.