Brookstone Schools of Mecklenburg County
Notification of Stock Transfer

Name(s)

Address, City, State, Zip

Email

Daytime Phone Number

Number of Shares

Name of Security

Expected Date of Transfer

Name of Brokerage or Bank

Broker City

Broker State

Broker Name

Broker Phone

This gift is (Choose One) This gift is (Choose One) Fulfilling a pledge For the general operating fund A Partner gift Designated for... (place designation in next box)

Designation (if applicable)