UTAH HORSE COUNCIL, INC.
                                                                
5615 N  6300 W
                                                           Mt. Green, UT  84050


                                                    
DONATION   REQUEST
                                                                  (  date  )

NAME & ADDRESS OF ORGANIZATION:


CONTACT  TEL. NUMBER:                

CONTACT PERSON:                        

FEDERAL TAX IDENTIFICATION NUMBER:
OR   TAX EXEMPT STATUS
                                                                                                    

AMOUNT    REQUESTED                        $ ___________

DESCRIPTION  OF  REQUEST:                 
(Detailed description of the purpose and how the funds will be used to promote your charitable functions)
(Please attach a second page if necessary)



    











SIGNATURE OF ORGANIZATION’S REPRESENTATIVE: ______________________________


UTAH HORSE COUNCIL, INC.  use only

    Date of Board Approval                _______________________________
    Board Signature                        _______________________________
    Date of Payment                        _______________________________
    Check Number                        _______________________________
Applications will be reviewed on:
June 30  &   Dec. 30
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