Certificate Transfer

Notification of Transfer

Richard Hugo House

Attention: Development
1634 11th Ave
Seattle, WA 98122
Fax: (206) 320-8767

I (We) are donating ________shares of _________________________________ common stock to be used as follows:

General operating: ________

Restricted program: ___________

My (our) broker is ____________________________________________________

Donor information:

Name(s): _____________________________________________________________

Address: ____________________________________________________________

City: ______________________________

State: _____________________________                 Zip: _______________

Telephone: _______________________________

Fax:_____________________________________

E-Mail:__________________________________

Date: ___________________________________

____ I wish to remain anonymous

____ I want my entire gift to be tax deductible; please send no premiums

____ I am making a gift  ____In honor   _____ In memory  of   ____________________