Thank You! We’re grateful you’re considering a legacy gift to support the ministries of the Diocese of Bridgeport. This form helps us understand your intentions so we can honor your wishes and plan for the future. It’s not legally binding—just a way for us to connect and serve you better.Whats Your Name?*We’d love to address you properly! Please share your full name. First Last Date of Birth MM slash DD slash YYYY Email Address Phone NumberAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parish NameSelect Your Parish,TownBlessed Sacrament Parish, BridgeportChrist the King Parish, TrumbullChurch of the Assumption, WestportHoly Cross Parish, FairfieldHoly Family and Saint Emery Parish, FairfieldHoly Name of Jesus Parish, StamfordHoly Name of Jesus Parish, StratfordHoly Spirit Parish, StamfordHoly Vietnamese Martyrs Quasi-Parish, BridgeportImmaculate Heart of Mary Parish, DanburyNotre Dame Du Perpetuel Secours Quasi-Parish, StamfordNotre Dame Parish, EastonOur Lady of Aparecida Quasi-Parish, DanburyOur Lady of Fatima Parish, BridgeportOur Lady of Fatima Parish, WiltonOur Lady of Grace Parish, StratfordOur Lady of Guadalupe Parish, DanburyOur Lady of Peace Parish, StratfordOur Lady of the Assumption Parish, FairfieldOur Lady Star of the Sea Parish, StamfordSacred Heart and Saint Patrick Parish, Redding RidgeSacred Heart of Jesus Parish, DanburySacred Heart Parish, GreenwichSacred Heart Parish, StamfordSaint Aloysius Parish, New CanaanSaint Andrew Parish, BridgeportSaint Ann Parish, BridgeportSaint Anthony of Padua Church, FairfieldSaint Bridget of Ireland Parish, StamfordSaint Catherine of Siena Parish, TrumbullSaint Charles Borromeo Parish, BridgeportSaint Clement of Rome Parish, StamfordSaint Edward the Confessor Parish, New FairfieldSaint Elizabeth Seton Parish, RidgefieldSaint Francis of Assisi Parish, WestonSaint Gregory the Great Parish, DanburySaint James Parish, StratfordSaint Jerome Parish, NorwalkSaint John Parish, DarienSaint Joseph Parish, BrookfieldSaint Joseph Parish, DanburySaint Joseph Parish, SheltonSaint Jude Parish, MonroeSaint Lawrence Parish, SheltonSaint Leo Parish, StamfordSaint Luke Parish, WestportSaint Margaret Mary Alacoque Parish, SheltonSaint Margaret Shrine, BridgeportSaint Marguerite Bourgeoys Parish, BrookfieldSaint Mark Parish, StratfordSaint Mary Parish, BethelSaint Mary Parish, BridgeportSaint Mary Parish, GreenwichSaint Mary Parish, NorwalkSaint Mary Parish, RidgefieldSaint Mary Parish, StamfordSaint Matthew Parish, NorwalkSaint Maurice Church, StamfordSaint Michael the Archangel Parish, BridgeportSaint Michael the Archangel Parish, GreenwichSaint Paul Parish, GreenwichSaint Peter Parish, BridgeportSaint Peter Parish, DanburySaint Philip Parish, NorwalkSaint Pius X Parish, FairfieldSaint Roch Parish, GreenwichSaint Rose of Lima Parish, NewtownSaint Stephen Parish, TrumbullSaint Theresa Parish, TrumbullSaint Thomas Aquinas Parish, FairfieldSaint Thomas More Parish, DarienSaint Thomas the Apostle Parish, NorwalkSS. Cyril and Methodius Parish, BridgeportSt. Catherine of Siena and St. Agnes Parish, GreenwichSt. Cecilia-St. Gabriel Parish, StamfordSt. Joseph and St. Ladislaus Parish, NorwalkThe Basilica of Saint John the Evangelist, StamfordThe Cathedral Parish, BridgeportLegacy Gift IntentionsLegacy Gift #1 TypePlease Select Your Gift TypeBequest in My Will or TrustDonor Advised FundIRA RolloverRetirement PlanStock or Appreciated AssetLife Insurance PolicyOtherIf other, please specify Legacy Gift # 1 DesignationPlease Select Your DesignationMy ParishDiocese of BridgeportFoundations in EducationFoundations in FaithFoundations in CharityLegacy Gift #1 AmountSelect your prevision(s) below. Specific dollar amount Percentage of estate/account Please enter the amountPlease enter the percentage Please estimate the current value of the giftOther Gift Details/RestrictionsWould you like to notify us about another legacy gift? Yes No Legacy Gift #2 TypePlease Select Your Gift TypeBequest in My Will or TrustDonor Advised FundIRA RolloverRetirement PlanStock or Appreciated AssetLife Insurance PolicyOtherIf other, please specify Legacy Gift #2 Designation (If Applicable)Please Select Your DesignationMy ParishDiocese of BridgeportFoundations in EducationFoundations in FaithFoundations in CharityLegacy Gift #2 Amount (If Applicable)Select your prevision(s) below. Specific dollar amount Percentage of estate/account Please enter the amountPlease enter the percentage Please estimate the current value of the giftOther Gift Details/RestrictionsWould you like to notify us about another legacy gift? Yes No Legacy Gift #3 TypePlease Select Your Gift TypeBequest in My Will or TrustDonor Advised FundIRA RolloverRetirement PlanStock or Appreciated AssetLife Insurance PolicyOtherIf other, please specify Legacy Gift #3 Designation (If Applicable)Please Select Your DesignationMy ParishDiocese of BridgeportFoundations in EducationFoundations in FaithFoundations in CharityLegacy Gift #3 Amount (If Applicable)Select your prevision(s) below. Specific dollar amount Percentage of estate/account Please enter the amountPlease enter the percentage Please estimate the current value of the giftOther Gift Details/RestrictionsSt. Augustine Legacy SocietyWould you like to become a member? Yes, I/we would like to become a member of the St. Augustine Legacy Society Thank you for joining the St. Augustine Society. As a member of the St. Augustine Society you will be invited to our annual induction mass with Bishop Caggiano. The Diocese of Bridgeport may include my (and, if applicable, my spouse's) name in the St. Augustine Legacy Society listings. (Neither amount nor designation, if provided, will ever be disclosed) I am honored to be included in the St. Augustine Legacy Society; however, I prefer that you keep my name anonymous and do not publish my name on any Society list If you have any questions about this form, please contact Steven Velardo, Senior Development Director, Leadership Gifts, at Steven.Velardo@diobpt.org (203) 416-1682.
