County of Warren

Department of Parks and Recreation

200 East 8^th Street

Front Royal, Virginia 22630 

Tax Receipt For Donation or Contribution

Warren County Skate Park Project

(Please fill out and return to the above address. Upon authorization, this form will be mailed back to you and will serve as the tax receipt for your donation/contribution. 

1. Monetary Donation/Contribution (amount):   $ ________________

      Checks made payable to: Treasurer of Warren County for

       Skate Park Project 

2. Supplies, Equipment, and/or Materials Donated (list below) 

      __________________________________________________ 

      __________________________________________________ 

      __________________________________________________ $ ________________

                                                               (Donated Value) 

3. Supplies, Equipment, and/or Materials Discounted (list below) 

      __________________________________________________ 

      __________________________________________________ 

      __________________________________________________ $ ________________

                                                               (Discounted Value) 
 

Individual (or) Business making Donation/Contribution: ____________________________

Address: _____________________________ City: _________________ Zip: _____________

Contact Person: ______________________________ Phone: __________________________ 
 

Donation/Contribution Received

County of Warren

Authorized Signature: _______________________________ _________________ 

                          Daniel P. Lenz, Director    Date 
 

It’s with great gratitude that we thank you for your generous contribution/donation to the Warren County Skate Park Project. Please have this form serve as the tax receipt for your donation/contribution. For your records, our tax-exempt number is 54-6001661.