(Date)
Gift Funds Coordinator -- Reconstruction of Iraqi Cultural Heritage
Cultural Property Office
U.S. Department of State
301 4th St., SW, Room 334
Washington, D.C. 20547
Dear Ms. Bishop :
(Name)________________ has made the following unconditional gift to the Department of State:
(Please list and describe gift, including approximate value)
We would prefer that this gift be used for the following purpose:
The following is a list of the subsidiaries/affiliates of (Company or Organization)_____________________:
(Company/Organization)________________________ has the following business pending
before the Department of
State and/or the following matters are likely to arise that might involve the
Department of State or the embassy:
(Please list and describe any matters that you or your subsidiaries and/or affiliates
have pending before the Department of State. Please also list and describe matters
likely to arise before the Department that would substantially affect you or
your subsidiaries and/or affiliates.)
(Signature)
Name:
Address: