NORMAN COLLINSON HOUSE
70 WALMGATE
YORK Y01 2T

Tel. (01904) 627995/621020

VAT Reg. No. 599 2580 80

Registered Charity No. 1118346
A company limited by guarantee.
Reg Company No. 6006449
Incorporated at Companies House,
Crown Way, Cardiff C14 3UZ

AGE CONCERN YORK
GIFT AID DECLARATION

This Declaration will enable Age Concern York to recover income tax and should only be completed if you are a taxpayer. You are able to cancel this authority if your circumstances change.

Declaration:-
I confirm that I am a taxpayer and authorise Age Concern York to recover Income Tax at the Standard Rate on all my recorded gifts to its funds until this authority is cancelled in writing.

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Title (please circle) Mr / Mrs / Miss / Ms / Dr / Rev

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