I designate that upon my death (or the death of my spouse), $____________ (or ________ percent) of my Qualified Retirement Plan (QRP) account be distributed to the University of Wisconsin-La Crosse Foundation Inc.
This gift shall be for the further benefit of the ___[COLLEGE, PROGRAM]__. Funds distributed from my QRP shall be used to provide __[PURPOSE]__. (If this gift is for the creation of an endowment, then the terms of the endowment should be set forth in a separate letter of instructions, to be referenced by the beneficiary designation form.)
Additional information for designation form:
Tax ID Number: University of Wisconsin-La Crosse Foundation Inc. 39-1145116
Mailing Address: UWL Foundation Inc.
Cleary Alumni & Friends Center, 615 East Avenue, North, La Crosse, WI 54601