Palominas Elementary School District Extra Curricular Activity Tax Credit Contribution Response Form Complete this form and return the completed form with your contribution to: Palominas Elementary School District Attention Tax Credits PO Box 38 Hereford, AZ 85615

To obtain a form online go to: http://www.palominasschooldistrict.com

First Name_____________ __ __ ____ Last Name___ _____ _____ ____ ___ Phone____________ ____

Mailing Address______________ ______________________ City________________________ State ______ ZIP ____________

Please direct my contribution to one or more of the following schools

$________ Palominas Elementary

$________ Coronado Elementary

$________ Valley View Elementary

$________ Total Contribution

I wish to designate this money for :

$________ General Fund

$________ Field Trips

$________ Athletics

$________ Band

$________ Fine Arts

As an Arizona taxpayer, you make take a school tax credit of $400 if married and filing jointly or $200 if single thus reducing your tax liability dollar for dollar.

If you have any questions please call the District Office at 520 366-6204.

You are eligible even if you do not have children attending school. Simply complete the form and send it with your payment to Palominas School District, PO Box 38, Hereford, Arizona 85615. You may also drop off your donation at the District office, 10391 East Hwy 92 or deposit it in the lockbox by the front door. Donations must be received by December 31st in order to qualify for a tax deduction for that calendar year.