Enclosed please find my contribution in the amount of:

____$25 ____$50____$100 ___$500 --- Other Amount $________

Name _______________________________

Address ______________________________

Address line 2 ______________________________

City__________________ State______________ Zip___________

Home Phone___________________ Business Phone_________________

Email Address______________________________________

---Mail Contributions to:

FF Sergio Villanueva Soccer Foundation
Jon Kanovsky, Executive Director
42-40 Bell Blvd.,
Suite # 601
Bayside, New York 11361

---All checks should be made payable to:

FF Sergio Villanueva Soccer Foundation

All contributions are 100% tax deductible and each donor will personally receive an acknowledgment of gratitude from the FDNY Soccer Team, Police Detective Jonathan Kanovsky, and the Villanueva family. A leather bound list of donors will be given to Ladder 132 and the family of Sergio Villanueva.