Heart of America Humane Society

Heart of America Humane Society
Honors, Memorials, & Gifts Donation Form
Please fill in the dedication for the donation
Dedication:
Address of the person who the donation is made in the name of:
First Name:	Last Name:
Address:
City:		State:	Zip:
Address of the person who is making the donation:
First Name:	Last Name:
Address:
City:		State:	Zip:
Notes\Special Instructions:

The Heart of America Humane Society
	P.O. Box 12703 • Overland Park, KS 66282
	Voice Mail: 1-800-384-3143
	E-mail:
The Heart of America Humane Society is a 501(c)(3) organization.
© 2009 Heart of America Humane Society

Donate