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an invitation to

THECIRCLEGARDEN

"a life of passion makes us a healthy cell in the body of the world"

planting seeds of self growth, with intention engaging in conversations that matter
table of contents The Invitation What is it? - An Opportunity for Growth How it Works - Opportunities, Roles and Responsibilities What are the Intangible Benefits? How Do I Enter the Circle? The Specifics The Circle Process: how it works Sample Blank Circle Chart & How the Circles Split The Four Circle Positions: opportunities, roles and responsibilities The Joy of Inviting Others: a how-to guide The Gifting Statement

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an invitation to

THECIRCLEGARDEN
"Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself." ~ Rumi

planting seeds of self growth, with intention engaging in conversations that matter
Hello and welcome! You are invited to join a community of remarkable women who have discovered an empowered way to help each other fulfill our dreams. We have joined together in a truly sacred community which supports the emotional and financial empowerment of women. If you decide to join our Circle you will learn more deeply about yourself in the process of giving and receiving both emotionally and financially. We have found that these are essential experiences. This journey has significantly benefited many women who have gone before us. Your opportunity for learning and growth will be reflective of your earnest involvement.

What Is It?
An Opportunity for Growth The Circle includes up to 15 women of diverse ages and backgrounds in different locations who meet by phone for 1 hour each week. We have conversations and share on topics ranging from talk about something that you are grateful for that happened to you this week to, tell the story of how it felt to receive your first paycheck, to share with the group what makes your best friend, your best friend. As part of the Circle, you will: more deeply learn about

giving and receiving support and nurture others grow and experience connection and community Learn to manifest your desires and create deep and lasting peace in your life.

How It Works
Opportunities, Roles Responsibilities & Rewards There are 4 growth positions that make up the Circle. We use the metaphor of the growth process of a flower to show how we each move around the Circle moving from Seeding to Sprouting to Blossoming and finishing

AN INVITATION TO THE THE GARDEN

this is a living, breathing circle

the energy we bring is the energy we receive


continuing to invite others. Inviting others is a natural process, as the circle will be a positive part of your life and you will feel inspired to share it with other women. Once you move through all the positions and reach Blooming, you are responsible for hosting the weekly calls and receiving eight $500 gifts, totaling $4000. Once you receive all 8 gifts you exit the Circle.

with Blooming. We are learning, giving and growing in different ways as we move through each position in the Circle. Each woman who participates in the Circle gives a gift of $500 to another woman in the Circle to support her in her financial empowerment and in manifesting her dreams. Each of us who has entered the Circle has given that same gift. Along the way we learn about ourselves, specifically who we are around money and how we share, invite, support, and emotionally engage ourselves and others. As you join the Circle you will begin in Seeding and are asked to do 3 things: Seeding 1. Give a gift of $500 to the woman in Blooming Sprouting 2. Invite others to join the Circle 3. Be on the weekly Circle calls. On the weekly call all you need to do is listen Blooming and share based on the topic that is presented. Blossoming Your responsibilities in Seeding and Sprouting are to join the calls each week, welcome new women onto the Circle, and invite others to join the Circle. You will move through seeding and sprouting as others join the Circle. To be able to move from Sprouting into Blossoming, you must have invited at least one other woman onto the Circle who has given a $500 gift to the woman in Blooming. In Blossoming, you are joining the weekly calls, supporting the other women in the Circle (especially the woman in Blooming), and

Circle Growth and Movement


The Circle is always moving, active, and circulating the energy of giving and receiving until it is complete for each woman. Each Circle begins with 8 people and grows into a group of 15. Once the Circle grows to 15 women, it splits into two new Circles. For the next women invited onto one of the new Circles the journey begins, while for others already on the Circle, the journey continues. Our Circle is not a hierarchy; it is a circle. There is no one at the top or bottom. Women are constantly cycling through ALL the positions. Its similar to the way cells divide in nature. One cell becomes two; two become four. Like this drawing of cell division:

We have a small, finite number of women. Everyone has exactly the same opportunity.

The circle is made up of women of diverse ages and backgrounds in different locations who meet by phone for 1 hour each week.

AN INVITATION TO THE THE GARDEN

we have the natural ability to inspire purely by being who we really are
Your Personal Growth and Movement
Your movement through the Circle will be according to your ability and willingness to trust, let go of limitations, invite others whom you care about into your new Circle community, and according to the group energy in your Circle. You will have the opportunity to be in Blooming as the group invites new women into the Circle, and then moves and cycles. After you have been fully gifted in the Blooming position, you may be inspired to continue your Circle journey. Many women are invited to return and cycle again, and many do; others simply move forward in their lives, expanded and supported. Each woman has her own specific areas of growth in which they find clarity. In the Circle... We learn how to listen and live true to our own internal voice. In our society we have learned to rely on others to tell us what to do and how to feel, even if what were told to do, doesnt match up with how we feel inside. In the process of moving through the Circle each person is asked to give, share, and receive of themselves according to what rises up. As we flex and grow this muscle we build confidence and clarity in who we are and how we show up in the world and the effects ripple through our entire lives. We learn how to receive, both financially and emotionally; it asks for a shift in consciousness in the way we identify ourselves in the world; it asks for a healthy balance of both giving and receiving. Many in the Circle come to realize and identify with the pure joy of receiving, thus creating a new balance in their lives. We learn to hold loving space for others on the call who might be asking for our support and guidance. We learn to trust in the concept of letting go. Entering the Circle is a leap of faith into community, connection, possibility and growth. This living workshop has the potential for true transformation. It is real life, real money, real community, and real sisterhoodwhere we have an opportunity to change, heal, and grow as we come face-to-face with our unconscious patterns of limitation. The women who will be your companions on this journey are all extraordinary. You will receive perhaps the greatest benefit from meeting, supporting, and being supported by these fabulous sisters who are there for you in the space of love. Intention is pivotal in manifesting one's dreams and visions in the Circle and in life. Our intention is to benefit women, its that simple. The Circle is a way to achieve personal growth, remove blocks to manifesting, and participate in a path to personal empowerment that teaches us to support ourselves and each other on many levels.

The Circle Calls


The Circle calls themselves take on different energies based on the woman facilitating the call. Her main responsibility is to set the intention for the call, ask a question, or give a prompt to start a discussion, and then hold space for women on the call to share. What happens on the calls is private and not to be talked about with others without permission as sensitive topics can arise. Be respectful of each others privacy to build trust and keep the integrity and sacredness of the Circle. Also Seeding remember to have fun and bring positive energy to the calls. The Sprouting calls are not a space for complaining, but are a place to be uplifted and inspired. Most of all we speak from the heart. The calls provide a great opportunity for growth by sharing this way.

Blooming

Blossoming

What Are the Intangible Benefits?


Many of the women who have gone before us have reported that when they entered, they did it because of the possible financial reward. After entering the Circle, their limiting beliefs and unconscious patterns came to the surface for healing. In the Circle we have opportunities to experience giving, supporting, nurturing, inviting and receiving. We have the opportunity to hear our own internal voices, speak from the heart, and have meaningful conversations around emotions and finances - they go hand in hand, even if many of us dont realize or admit it.

AN INVITATION TO THE THE GARDEN

the growth of our most knowing self learning to listen from the inside
Who is Invited?
In order to support the strength and integrity of the Circle we invite strong, mature, women of integrity who are committed to personal and spiritual growth. We will attract women who can contribute their intentions and energies to our goal of supporting each other. emotionally, mentally and spiritually. There is wisdom in SELF-FULLNESS when you take time to care for yourself. During the hour call, is where your cup can be filled by being fully present, sharing of yourself and listening to others. By being a part of this organic garden, this will affect your life in ways you cant even imagine. How you take care of your garden is a reflection of how you take care of your life. The opportunity on the entire journey of the Circle is to look at your own relationships and beliefs. Like any thing in life, the more you put into it the more you will get out of it.

How Do I Enter the Circle?


The Invitation Call The first step is to have an Invitation Call with the friend who invited you and the woman who is in Blooming. After you have completed this brief call around the mechanics of the Circle, you may choose to be a guest on the weekly conference call or you may know that you are ready to join the Circle. You do not have to have your gift in order to decide the Circle journey is right for you. For many women the money for their gift shows up after they have made the commitment to the Circle. What is most important is that you come to a decision from a place of informed guidance. This inner guidance, and the faith that comes from it, is the foundation for you to have a deeply fulfilling and rewarding experience in your Circle journey. Once you have had an opportunity to hear more details about the Circle and ask any questions you may have, go within to a quiet centered place and use your intuition to make your decision. Trust Yourself! If you are ready to expand yourself in many ways and this Circle is calling to you, you will know it.

Tools
What tools do you have in your shed that you can apply, dust off and make useful to care for your garden. Our life has unlimited possibilities and options that are often forgotten. You may notice yourself feeling more alive and aware of tools that you have forgotten or didnt even know existed. As you begin to look deeper, become more hands on in your life, you will discover abilities and strengths you didnt know you had. New tools are received from hearing others share their lives and how they work through lifes experiences.

Love is a Currency
When you say the word currency, most people think of an exchange of money, or something relating to money. But the word currency is defined as "an exchange from person to person, in circulation." There are actually many types of currency. Love, for instance, is a currency. It is something we give and receive and it is often the most highly prized. Our time and attention is a currency, trust is a currency, knowledge is a currency, and so is our energy. As you spend time in the Circle, you will notice there are many currencies being exchanged, financial being only one of them. So what currencies will you bring to this exchange, and what currencies are you open to receiving? Come ready for a full exchange that will fill your heart and mind. Joining the Circle is an invitation to personal growth and transformation. We would love to have you become a part of it!

The Living Workshop


My cup runneth over and whatever is overflowing from the cup is for others but what is in my cup is for ME. Iyanla Vanzant. You may have consciously or unconsciously been asking to experience self growth, abundance, and deeper connections with other women who are consciously living their lives authentically. Each woman is working on her own growth, and as a group, we are all growing a beautiful Garden. This Garden is organic, just like life, it is a breathing, living energy that requires TLC. It requires consciousness to know what is needed. It requires commitment and dedication for growth. The weekly call is the time that is for YOU to nurture and feed yourself with wisdom and create connections on many levels: physically,

Pause here...
No need to read further until youve decided to join the Circle...
Some people like to have all the information right up front, and others would prefer to get it when they need it. So, if you would like to read more about how the Circles work before your Invitation Call, feel free to continue on to Part 2: The Specifics, which is next. Otherwise well see you on your Invitation Call!

this is a living, breathing circle


how it works
This part of the document goes into more detail about how the Circles work, the roles and responsibilities for each position, and guidelines to help you in making your Information and Invitation Calls. Some information shared in the introduction may also be included in part 2 as a way to provide context as more details are made explicit. The entire document is a resource provided for you as you move through the Circle journey from Seeding to Blooming. Were excited that youre a part of this amazing journey!

The call is the time for YOU to nurture and feed yourself with wisdom. You will create connections on many levels: physically, emotionally, mentally and spiritually. There is wisdom in SELF-FULLNESS when you take time to care for yourself.

The Circle Process


Our Circle is not a hierarchy; it is a circle. There is no one at the top or bottom. Women are constantly cycling through ALL the positions. Its similar to the way cells divide in nature. One cell becomes two; two become four. Like this drawing of cell division:

The Circle is always moving, active, and circulating the energy of giving and receiving until it is complete for each woman. Each Circle begins with 8 people and grows into a group of 15. At any given time the Circle includes up to: 8 women Seeding, 4 women Sprouting, 2 women Blossoming, and 1 woman in Blooming

We have a small, nite number of women. Everyone has exactly the same opportunity.

The positions in the circle are lled in order of when each woman joins.

Once the Circle grows to 15 women, it splits into two new Circles. In the split, the two women in Blossoming each move into Blooming and begin their own Circle. The 4 women in Sprouting move into the Blossoming positions, provided they have each given their $500 gift and have invited another woman who has also given their $500 gift. The 8 women in Seeding move to the Sprouting positions in the 2 circles. Finally, 8 spaces open up in the Seeding position, 4 in each new Circle. See Sample Circle Chart on page 8.

The Circles Grow Through the Invitation Process


It starts when a woman on the circle, she could be Seeding, Sprouting, Blossoming, or Blooming, identies a friend that she thinks would be a good addition to the Circle. She tells her about the Circle, following the hints and tips found in the Invitation Call - The Joy of Inviting section, and invites her for a phone conversation with herself and the woman in Blooming. When the woman in Blooming is not available one of the women in Blossoming can be on the call instead. Once the invited woman decides to join the Circle she moves into a Seeding position. When all the Seeding positions are lled, the Circle splits again.

As women we often find it more comfortable to give than to receive. You have the opportunity to experience both in this garden. Its a safe place to take a look at your beliefs about giving and receiving.

Question: How long do I have to bring my gift and a friend?


Start right away, even if you don't know how your gift will be created or whom you will invite. What are the tools you currently use to get you out of fear and scarcity thinking and into the flow? Engage those now. Connect with the woman who is Blooming to support you in manifesting your gift and inviting others. We are a group that supports one another.

sample circle chart and visual of how the circles split

Sample chart

How the circles split

the 4 positions around the circle opportunities, roles, responsibilities


The Four Positions Around the Circle
Opportunities, Roles Responsibilities Four Positions for Emotional and Financial Growth 2. Be on the weekly Circle calls As each week continues you will become more and more comfortable on the weekly calls and be building bonds with the other women. Youll find that as the weeks continue you will experience a deepening of the growth process on the calls as your trust increases in others on the journey with you and with your own internal voice. If you did not invite a woman to join the circle who has given the $500 gift to the woman in Blooming, youll need to find someone to ask who will complete her gift before moving into the Blossoming position.

1. Seeding: Learning Emotionally


Seeding Sprouting Blooming Blossoming

and Giving Financially

2. Sprouting: Asking/Inviting and


Growing Emotionally

3. Blossoming: Nurturing and


Growing Self and Others

4. Blooming: Emotionally
Supporting Growth and Receiving Financially

3. Blossoming: Nurturing and


Growing Self and Others While Blossoming you have 3 Responsibilities 1. Support and nurture others on the Circle 2. Continue to invite others to join the Circle 3. Be on the weekly Circle calls In Blossoming, one of your main responsibilities is to support the woman in Blooming. This serves two purposes: you will be learning the role and responsibilities for when you reach Blooming; and you have the opportunity to grow your own supportive, nurturing skills. As part of the weekly calls you may help choose the topic or even host the call if needed. Blossoming is also asked to nurture the other women in the Circle, giving support as they invite others, and simply checking in to see how others are doing. You have the ability to continue the movement of the Circle and can be a great resource and help to the woman in Blooming.

1. Seeding: Learning Emotionally


and Giving Financially In the Seeding position you have 3 Responsibilities 1. Give a gift of $500 to the woman in Blooming 2. Invite others to join the Circle 3. Be on the weekly Circle calls. On the weekly call all you need to do is listen and share based on the topic that is presented and your comfort level. Each person is given the opportunity to share, but may decide to simply listen. In the Seeding position you have the opportunity to get comfortable with the process and start to explore elements of community, feelings around giving money without expectation, and anticipating what it will be like to identify and invite a friend to join the Circle. You are highly encouraged to be on each of the calls, and we ask that you attend at least 90% of the calls. Even if youre not feeling well, many women have found it helpful to silently listen to the calls. You will receive and get to read the bios of the other women on the call as another way to get to know them better. We will also be requesting your bio (an opportunity to think about how you present yourself to the world). Any one of these activities may not be difficult for you, but usually there is one or two that will stretch your growth.

4. Blooming: Emotionally
Supporting Growth and Receiving Financially While Blooming you have 8 Responsibilities Host the weekly Circle calls Support and nurture others on the Circle Share the Circle document with those being invited Hold the Invitation Calls Continue to Invite others to join the Circle Update and share the bios and Circle Chart Update and share the Circle Chart Receive the eight gifts of the new people joining the Circle

1. 2. 3. 4. 5. 6. 7. 8.

2. Sprouting: Asking/Inviting and


Growing Emotionally While Sprouting you have 2 Responsibilities 1. Invite others to join the Circle

the 4 positions around the circle continued...


Blooming responsibilities continued
1. Hosting the weekly Circle calls - you pick the topic and invite everyone on the call to share their thoughts and feelings on the topic. Possible topics include: a question about something that happened during the week, a more existential question, express something you have gratitude around, how can we create more of what works for us on a regular basis?, how can we support and help each other? etc., Be sure to pick something that inspires you, because if it inspires you, then it will inspire others. Every person on the call has the opportunity to talk, and also has the option to sit silently on the call. To facilitate the call, you can either draw circle, write names around the circle, and ask the women to take turns following the virtual circle, or if there is a smaller number the popcorn approach can work, where you open the call to allow whoever wants to speak to begin, followed by the next person who is moved to speak and so on. Your job as facilitator is to hold space for the women on the call to share their positive reflections on the topic. It is important to keep the calls to one hour to honor the schedules of everyone on the call. Somehow, every time we have had a circle call we never go longer than 60 minutes. Even if one of the women seems to be taking a long time to talk, the calls always seem to end on time. Keeping the confidentiality of the calls is important what happens on the calls is private and not to be talked about with others without permission as sensitive topics can arise. Be respectful of each others privacy to build trust and keep the integrity and sacredness of the Circle. 2. Support and Nurture others on the Circle - this responsibility is fun and feels good. By the time you have reached the Blooming position you know the women on the circle in a deep way. Whether it is a phone call, or an email of encouragement and connection supporting and nurturing others mostly comes in small ways that can add up to make a difference. 3. Share the Circle document with those being invited - this is a simple to way to make the connection with the new woman being invited, and takes place via email. 4. Hold the Invitation Calls - your role on these calls is to guide the person inviting through the process of sharing about how the Circle works and what the new person might expect. Answer any questions on the call and hold space for the person to make their own decision from their internal knowing. 5. Continue to invite others to join the Circle - this is simple. The more people invited to join, the faster the Circle will complete. 6. Update and share the Personal Bios - each woman is invited to share a photo and a paragraph about herself. These are compiled in an email and sent to those on the Circle. The bios are a great way to build connection. A tighter group makes the calls more inspiring, and creates an atmosphere where people want to join the calls and also invite their friends. Once a woman officially joins the Circle, invite her to share her bio too. Share the updated bio page with the existing Circle members so they can meet the new person and welcome her. 7. Update and share the Circle Chart - it is helpful for everyone to know where they are in the process and to know what responsibilities they have in each position. Share the updated Circle Chart with each new woman who joins the Circle and with the other members of the Circle too. 8. Receive the 8 gifts of the new people joining the Circle - to receive the gifts of the new people joining the Circle you send the Gifting Statement (see the last page of this document). Be sure to instruct the person giving the gift to include the Gifting Statement or a note describing the money as a gift. Also, it is very important that you have the sender use UPS, FedEX, or some other private carrier and not the US Postal Service. Once you receive the gift use it to empower your dreams. Once you receive all 8 gifts, the final call of this particular Circle will be a celebration call to honor your service to the Circle. Once the process is complete you exit the Circle.

Backing
Every woman in the Circle at any time has the option to step out of the Circle. If a woman steps out, she becomes a backer for someone else joining the Circle, or for someone on the Circle who has not yet manifested their gift. If a woman steps out her money stays with the person in Blooming since it was given as a gift. Typically, at the end of the cycle, a backer will split the $4000 with the person traveling on the Circle. In the partnership the Backer provides the financial energy and the person on the Circle provides the energy of time and attention. If you are not invited to take a backed position and you cannot manifest the money yourself, someone else may give the financial gift ($500) for you, allowing you to join the Circle. This person then becomes your "backer. Whatever personal arrangements you make with someone else to fund your gift, is wholly your business.

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the joy of the invitation how to invite others to the circle


5 Easy Steps to inviting others
Step 1 Choose whom to invite
Some women have an immediate inspiration about who they would like to invite onto the Circle. Others take a little time to think about whom they want to invite. Either way, trust your intuition and your internal voice to find the women you are interested to invite. Remember that youll be connecting with these woman each week on the Circle calls. Think of someone whom you would like to get to know better, or someone you believe would be a good person to join the Circle. available, either of the women in Blossoming can be on the Invitation Call. Prior to the Invitation Call, send the circle document, telling the person being invited that she can read the whole document if she wants, but only needs to read the Invitation Section (on pages 1-4). Hold the 3-way Invitation Call, giving the woman being invited the option of joining the Circle right away or listening in on the next Circle Call. On the call just be yourself. The woman doing the inviting will introduce the woman being invited and the woman in Blooming. Have a conversation like you would at a cafe. Each woman who is already on the Circle will talk about their experiences on the Circle and what they are getting out of being on it. The woman in Blooming can then explain how the Circle works, referring to the Invitation document when it makes sense. Then open up the call for any questions. Remember, the woman being invited needs to be given space to make her own decision. Simply share about what the Circle is about for you and let the woman being invited make her choice between not joining the Circle, listening on a call to get a feel for the energy of the Circle, or deciding the Circle is right for her, and joining right away. You can do unlimited 3-way Information Calls with the woman in Blooming. The more inviting you do, the more women will come into the Circle creating movement.

Step 2 Invite a woman to learn about the Circle ~ Speaking From Your Heart
Inviting is easy and fun. Relax and be yourself with the people whom you invite. Be sure to share from your heart. People are looking for a way to bring growth into their lives and most everyone is happy to hear about the Circle and what it means to you. Share your excitement and passion for the Circle, talking about the calls, the connection, and your learning and growth. Talk about why you want this specific woman to join the Circle. You could pick from dozens of friends, why did you chose this particular woman? Once you engage the other person with your interest in her and your passion for the calls, you can talk about whatever details seem most important to you. Dont worry about covering all the bases - thats where the Invitation Call and the Circle document are useful. Read the document as many times as you need to feel comfortable with the details.

Follow up:
The follow up is a courtesy and an opportunity to support your invitee in having the information she needs to determine for herself if the Circle is right for her at this time.

Step 3 The Invitation Call


Arrange a 3-way Invitation Call with the woman in Blooming. Contact the woman in Blooming to arrange a time to have the 3-way Invitation Call. If for some reason the woman in Blooming is not

Step 4 Listen in on the weekly Circle call


If the woman being invited is interested, she can then either listen in on the next Circle call or send her gift to the woman in Blooming to officially join the Circle.

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the joy of the invitation continued


If the woman is interested in listening in on or joining the Circle, the bio page can be sent to her, if she would like to know who will be on the call with her. Remember to give your guests a courtesy call or text the day of their first call to make sure they have the conference call number and time even if you've already given it to them. By the time she comes onto the call, she will already have a solid understanding of the Circle Process, know that she is in alignment with it, and have some ideas about the value of the Circle for her. Be in the position to support the woman being invited in any way you can, even if that is simply sending her good energy while she makes her decision. After the Circle call connect with her, asking her what she thought. If you don't hear back from your guest, leave a message thanking her for being on the Invitation Call and the weekly Circle call and let her know that you and your sisters on the Circle are available for information if she would like that--and then, leave it. If she is interested, shell connect with you, even if it is to ask more questions or talk through her thoughts. Even if she is interested, it might not be the right time for her to join the Circle. Remember to let the woman being invited to listen to her own internal voice to make her decision, just as you needed to listen to your own internal voice to make your decision.

Steps 5: She said YES!


Once the invited woman sends in her gift, definitely send the bio page if it hasnt already been sent, and send the updated Circle Chart Celebrate the new woman joining the Circle. Write her a special email, give her a call, or write her a note. We will celebrate her joining the Circle on the next call. Celebrating gives energy to all the women on the Circle and inspires Circle members to stay involved and invite others for growth and movement.

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GIFTING STATEMENT
Any and all property of any nature that I transfer from my ownership and possession to _______________________________is intended as a gift and not as an investment. I have not been sold anything and I have not purchased anything, and I have not been offered any opportunity to do so. I have been told to not expect any return of any nature, and I received no license or privilege of soliciting or recruiting other parties to participate in any activities. With this affidavit I waive any and all rights to civil or criminal remedies against the recipient of my gift. I perceive no agreement between myself and the recipient of my gift, and I expect no profit, benefit, or opportunity of any nature in consideration for the property that I have transferred as a gift. Therefore, I have not purchased a security. My intent is to give a gift, given out of detached and disinterested generosity, and I do not intend the gift as an investment, or as a payment for which I am owed anything of any value or nature, and I acknowledge that my gift does not entitle me to any future opportunity or benefit of any nature. I understand that _____________________________ accepts only gifts and that they absolutely do not accept any property offered with the intent of its owner that a future return or opportunity be obtained or secured by virtue of their having transferred said gift to another individual. Therefore, I have not purchased a security. I have agreed under this gift contract to not reassert any rights to the property that I now give freely as a gift to another individual. I am a fully informed and consenting adult and I have not been misled in any way. This contract is hereby formed in the state wherein the recipient of this gift resides. I, ________________________________, do hereby declare under penalty of perjury that the foregoing statements are true and correct, and are binding upon me to the full extent therein. Signed: _______________________________________________________________ Printed Name: __________________________________________________________ Date: __________________________________ Amount of Gift: __________________________

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