Annual Application — EMMANUEL MERCY MISSION

🔒 SECURE LEGAL INTAKE

ANNUAL APPLICATION TO RECEIVE GIFT-IN-KIND

Emmanuel Mercy Mission • 2021 NW Sundial Rd. #-5 • Troutdale, Oregon 97060

I. Organization Information

Organization Legal Name *

Street Address *

City & State/Region *

Postal Code *

Country *

Federal Tax ID / Registration Number *

Website or Official Social Media Link

II. Primary Contact Individual

Full Name & Title *

Official Email *

Phone Number (with Country Code) *

III. Mission Statement & Objectives

Organization Mission Statement & Objectives *

IV. Document Verification & Legal Compliance

Upload Required Documents (Copy of 501(c)(3), Legal Registration, Charter, or Board list) * Accepted formats: PDF, Word, Images. Maximum size: 10MB.

LEGAL AUTHORIZATION & CERTIFICATION STATEMENT *
As chief executive officer of the organization, I certify that the information set forth in this application is true and correct. I certify that all products received from Emmanuel Mercy Mission will be used exclusively for the treatment of the ill, needy, and infants at the project site. Products will be provided to those in need at no cost to the patient and will not be transferred, sold, or used for barter.