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<td><img src="media/image2.wmf"
style="width:0.82153in;height:0.825in" /></td>
<td colspan="4"><p><strong>HEADQUARTERS</strong></p>
<p><strong>CALIFORNIA WING - CIVIL AIR PATROL</strong></p>
<p><strong>UNITED STATES AIRFORCE AUXILIARY</strong></p>
<p>P.O. Box 7688 Van Nuys, CA. 91409-7688<br />
PHONE: 818-989-8100 FAX: 818-989-8108</p></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="11"><h1 id="certificate-of-donation">Certificate of
Donation</h1></td>
</tr>
<tr class="odd">
<td colspan="4"><p>Receiving Unit Name and Number</p>
<p>     </p></td>
<td colspan="5"><p>Charter No.</p>
<p>CA-   </p></td>
<td colspan="2"><p>Group No.</p>
<p> </p></td>
</tr>
<tr class="even">
<td colspan="4"><p>Full name of Donor</p>
<p>     </p></td>
<td colspan="7"><p>Social Security No. or Taxpayer ID No.</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="4"><p>Residence of Donor, Street</p>
<p>     </p></td>
<td colspan="4"><p>City</p>
<p>     </p></td>
<td colspan="2"><p>State</p>
<p>  </p></td>
<td><p>Zip+4</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="11">I certify that I am voluntarily donating my personal
resources of the kinds listed below, and/or the items listed below, to
the Civil Air Patrol. I further certify that I understand title to the
donated items or the property identified below, on which my personal
resources may be expended, will be vested in the Civil Air Patrol
Corporation, that I will have no further right, title, interest in, or
claim against such property, and that when the property has no further
utility to Civil Air Patrol it must be disposed of in accordance with
applicable CAP directives.</td>
</tr>
<tr class="odd">
<td colspan="3">Dated this, the    Day of    , 20  </td>
<td colspan="3">Signature of Donor</td>
<td colspan="5"><p>Home Phone &amp; Area Code</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="11"><h1 id="description-of-property-donated">Description of
Property Donated</h1></td>
</tr>
<tr class="odd">
<td colspan="11">     </td>
</tr>
<tr class="even">
<td colspan="11">Total Value $      (Entered and Claimed by Donor)</td>
</tr>
<tr class="odd">
<td colspan="11"><p>Civil Air Patrol accepts the property and/or
services indicated above. Civil Air Patrol is a tax exempt organization
under 501[c][3] of the Internal Revenue Code. The valuation of the
property and/or services donated and the deductibility thereof remain
the responsibility of the Donor as specified in the Internal Revenue
Code.</p>
<p>NOTE: Must be signed by Corp. Officer</p></td>
</tr>
<tr class="even">
<td colspan="2">ACCEPTED FOR CIVIL AIR PATROL, INC. (Signature)</td>
<td colspan="5"><p>Title: Commander, California Wing</p>
<p> Commander, Pacific Region</p>
<p> National Headquarters</p></td>
<td colspan="4"><p>Date:</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="11"><strong>CAWG Form 55e Mar 2005</strong> Previous
Editions Are Obsolete</td>
</tr>
<tr class="even">
<td colspan="11"><h2
id="where-individual-performance-meets-caps-potential">Where Individual
Performance Meets CAP's Potential</h2></td>
</tr>
</tbody>
</table>