Please fill out the following form and send to:     Chaya     P.O. Box 22291     Seattle, WA 98122
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* Please make checks payable to Chaya.
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Please accept my donation in the amount of: $1,000 $500 $250 $100 $50 $35 $25 Other $
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Donations are tax deductible to the extent allowed by law. Chaya's federal tax ID number is 91-133 8554.
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