Virginia General Fund Donation Voucher

General Fund Donation Voucher
GFD W 01 10 12.indd
Form GFD

Virginia Department of Taxation
General Fund Donation Voucher

The Virginia General Assembly, in the 2002
session, passed legislation providing that a
taxpayer wanting to donate money in excess of
his tax liability to the Commonwealth may do so
at any time by writing a check payable to the State
Treasurer and designating it as a donation to the
Commonwealth’s general fund. Such donations
will be used only for public purposes. Currently,

these donations are also allowable as itemized
deductions under IRC §170. Taxpayers making
donations pursuant to this section may (i) include
their donations when filing their Virginia income
tax return, or (ii) deliver such donations, either in
person or by mail, to the Tax Commissioner. " Va.
Code §58.1-17.

Fill in the amount of your General Fund
donation in the boxes below to the right.

Sign and date where indicated. If both spouses'
names are given then both spouses must sign
and date the voucher.

Fill in all requested information in the SSN,
name and address boxes. If this is a joint
donation, please enter spouse's SSN and
name.
Check one box at the bottom of the page to
show whether or not you want your name(s)
listed on the Department of Taxation web site
as a General Fund Donor. Make a note of your
selection below for your records.
	

Put names on Web-site, www.tax.virginia.
gov. I(we) understand that no other identifying
information, including donation amounts, addresses
or social security numbers will be made public.

	

Do not publish my(our) name(s) on Web-site.

Please give a daytime phone number in case
we need to contact you about your donation.
	 Date Donation Sent
	 Check Or Money Order Number
	 Donation Amount $

Cut on the dashed line below; save the top section for your records; mail the voucher below to the address on the voucher.
office use only

Make Check or Money Order Payable to:
State Treasurer

Please do not staple

FORM GFD General Fund Donation Voucher
Virginia Department Of Taxation
P.O. Box 2468, Richmond, VA 23218-2468
For Information Call 804-367-8031

00000000

Donation Amount

.

0000000 000000

Your SSN Or VA Account #	

Your First Name (Or Business' Name) 	

MI	

Last Name	

Suffix

 Spouse’s SSN	

Spouse’s First Name	

MI	

Last Name	

Suffix

 Address (Number And Street)	

	
	

City	

State 	

Zip Code

	 Please publish my(our) name(s) on the list of donors posted on the Department of Taxation Web-site: www.tax.virginia.gov. I(we) understand
that no other identifying information, including donation amounts, addresses or social security numbers will be made public.
	 Please do not publish my(our) name(s) on the list of donors.

Your Signature	
Va. Dept. Of Taxation Form GFD W Rev. 1/12

Date	

Spouse's Signature	

Date	

Daytime Telephone Number