Bonita Elementary School

2016 Arizona Tax Credit Request



Name  _____________________________________  Social Security # __________________


Address _______________________________________________  City _____________________  Zip__________


Phone _________________________________   Fax _____________________


I wish to make monthly donations                 (If so, please duplicate this form, or call the district office, 384-3237 or 828-3363, for additional forms).


Complete this form and mail to:        


Bonita Elementary School District #16

18008 South Fort Grant Rd.

Bonita, Arizona 85643


Apply my tax credit to the following school:


       Bonita Elementary School      K-8                  Mr. Ed Houser, Superintendent

                                                                                             (928) 828-3363 or (520)384-3237

Apply my tax credit to the following program:


       School may designate program use    


       Remedial programs


       Enrichment programs


       Fine Arts




       Field Trips


       Specific department use