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Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
In what county in Indiana did you make your donation? *

This form is ONLY valid for donations made in Northeast Indiana.
Which Goodwill Donation Center did you use? *
Ft. Wayne North - St. Joe Village Shopping Center Ft. Wayne North - Kroger on North Clinton Ft. Wayne North - Glenbrook Commons Ft. Wayne North - Dupont Village (behind store) Ft. Wayne North - Stellhorn Village Ft. Wayne Northeast - Chapel Ridge Shopping Center Ft. Wayne Southwest - Rural King on West Jefferson Blvd Ft. Wayne Southwest - Times Corners Ft. Wayne Southwest - Corporate Office - 1516 Magnavox Way Ft. Wayne Southwest - Village at Coventry Ft. Wayne Southwest - Hires Automotive on Illinois Huntington - Huntington Plaza Columbia City - Columbia Square Columbia City - Tractor Supply on North Main

This form is ONLY valid for donations made in Northeast Indiana.
What Did You Donate? *
Clothes Shoes Household Wares Furniture Computers and/or computer accessories Electronics Cash Donation

GOODWILL WORKS SO PEOPLE CAN: Goodwill is a private, not for profit corporation and is tax exempt under Section 501 (c) (3) of the Internal Revenue Code. Goodwill is dedicated to helping people with disabilities and employment barriers achieve their potential through the dignity and power of work.
TAX RECORD FORM: Federal law provides that for a tax deduction, clothing and household goods must be in "good used condition or better." This form is an electronic record of your donation. All values are assigned by the donor. Please read section 526 of the IRS tax code for more information.
Total Value of Your Donation
Date of Donation
Do Not Fill This Out

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