Irrevocable Contribution Form and Letter of Instruction Completed Form Examples and Samples

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Completed Fidelity Charitable Irrevocable Contribution Form and Letter of Instruction for an appreciated stock donation from a Fidelity brokerage account to a Giving Account

Source document used: Financial Advisor Client Memo

CLIENT CHARITABLE GIVING MEMO
Prepared by: Daniel Osei, CFP®
Osei Wealth Advisors, LLC
Date: February 18, 2026

Re: Year-End Charitable Planning – Margaret Harrington

This memo summarizes the agreed-upon charitable giving strategy for our client Margaret L. Harrington (SSN: 412-77-9034), a U.S. citizen residing at 84 Birchwood Lane, Concord, NH 03301. Best contact number is (603) 555-0182.

Margaret has held a Fidelity Charitable Giving Account for several years under account number 7741-8823, registered as the Harrington Family Giving Account. She has confirmed she is the account holder (not a third-party donor) and wishes to make an irrevocable contribution of two appreciated stock positions currently sitting in her Fidelity brokerage account (account number X47-293011).

Position 1: 350 shares of Apple Inc. (AAPL). The lot was acquired on March 14, 2019, at a cost basis of $38.72 per share (total lot cost: $13,552.00). These shares have appreciated significantly and contributing them directly avoids capital gains tax.

Position 2: 200 shares of Microsoft Corporation (MSFT). This lot was acquired on July 22, 2020, at a cost basis of $203.50 per share (total lot cost: $40,700.00).

Both positions are held in the same Fidelity nonretirement brokerage account (X47-293011).

For the investment pool allocation within the Giving Account, Margaret has requested the following split: 60% to Asset Allocation 70% Equity Pool and 40% to U.S. Bond Index Pool, which aligns with her moderate growth charitable investment philosophy. She does not wish to use the CIAP managed account option.

Margaret plans to support three local nonprofits over the next 18 months using her Giving Account balance — Concord Food Bank, the New Hampshire Land Trust, and a scholarship fund at Concord High School. No goods or services were received in exchange for this contribution.

Please ensure the form is signed by Margaret and submitted to Fidelity Charitable promptly. I've advised her to retain a copy for her tax records, as this contribution is expected to generate a significant charitable deduction for the 2026 tax year. If there are any questions, she can be reached directly at the number listed above.

– Daniel Osei, CFP®
Osei Wealth Advisors, LLC
(617) 555-0344