Forms & Documents

Forms

Forms To Establish Trust Accounts

Account Agreements
2014 Flexible Spending Pooled Trust Account Agreement
Gift Annuity Account Agreement
Third Party Trust Account Agreement
*Account agreements require an original signature and cannot be e-signed.

Accompanying Documents
Beneficiary Profile E-Sign  Download
Form W-9 E-Sign  Download
Memo to Donors E-Sign  Download
Duties & Responsibilities of Personal Representative E-Sign  Download
Guardianship Attestation (For Representative Payees) E-Sign  Download
Disability Determination Physician Statement

Forms for Distributions

2014 Flexible Spending Trust Distribution Form
E-Sign  Download

Original Flexible Spending Trust Distribution Form (April 2021)
E-Sign  Download

Gift Annuity Distribution Form
E-Sign  Download

Third Party Pooled Flexible Spending Trust Distribution Form (May 2021)
E-Sign  Download

Lost Receipt Form (Oct 2019)
E-Sign  Download

1401 S Main St.
Suite 100
Dayton, OH 45409

937.225.9939

The Dayton Foundation Logo

DISCLAIMER
A supporting organization of The Dayton Foundation. The Disability Foundation maintains its own 501(c)(3) tax-exempt status and receives backing from The Dayton Foundation to support daily activities and monitor financials.

©2024 The Disability Foundation

Skip to content