Dear Friend: Thank you very much for your interest in joining our “Kidney Cars” Family! The Kidney Cars program is a special way to fight kid-ney disease by donating your vehicle to help further our programs and services here in Hawaii.

Your donation funds: • Free Statewide Kidney Screenings • Free Youth • Medical Research & Organ Donation Initiatives • Medical Professional Education • Free Medical ID Jewelry • Free Calabash Cookbook • Free Kidney 101 presentations • Free Statewide Kidney Health Education • Support Groups, Peer Mentoring and Financial Assistance for Patients

Other ways to help: • Enjoy a tax deduction by donating real estate, stocks or including us in your will. Call (808) 589-5976 for details. • Participate in our many special events. Go to www.kidneyhi.org for listings.

Did you know that Hawaii’s kidney failure rate is 30% higher than the national average? Chances are good that you know someone with kidney disease or are even afflicted yourself. Whether or not you decide to donate your vehicle, please read about the early warning signs of kidney failure and ask for a free kidney screening. Knowing the early warning signs just might help prevent kidney failure in your life or the life of someone you love. The warning signs are:

• Burning or difficulty during urination • More frequent urination, particularly at night • Passage of blood-appearing urine • Hypertension • Puffiness around eyes, swelling of hands and feet (especially in children) • Pain in small of back just below ribs (not aggravated by movement) • Diabetes

Nearly 300,000 Hawaii residents at serious risk or afflicted by kidney disease, your vehicle donation helps us reach out to thou-sands of families each year. As we continue to increase and expand our programs and services that focus on preventing kidney disease and providing support for our kidney patients and their families, every donation makes a difference.

You may have heard that tax laws have changed, but one thing remains the same—DONATING YOUR CAR IS STILL A GREAT WAY TO GET A GREAT TAX DEDUCTION. Here at the National Kidney Foundation of Hawaii, we care about our donors and we are taking every step necessary to get you the best tax deduction possible.

We look forward to hearing from you and thank you again for supporting the National Kidney Foundation of Hawaii.

Sincerely,

Glen Hayashida Chief Executive Officer

EXTRA CLOTHING ITEMS OR HOUSEHOLD GOODS?

Donate them today; Call 596-7575

The donation process is pretty easy, a few simple steps and you’re on your way to making your car a Kidney Car!

Step 1: Fill out and Sign all Forms and Documents Listed Below:

Donor Information and Disclosure Form

Kidney Car Assessment Form

Car Location Information Form

Most current Registration and Safety Inspection — Optional

Step 2: Mail a signed Certificate of Title to: Kidney Cars 1314 S. King St # 722 Honolulu, HI 96814

• See the Title Sample page for signing instructions

The Notice of Transfer is located at the top of your Certificate of Title — the DMV requires that the Notice of Transfer be filed with in 10 days of the transfer of the vehicle.

• At your request NKFH will file your N.O.T for you — please leave the “date of transfer” space at the top blank; sign the signature and address line, include it with your title. It will be dated when we confirm the vehicle has been picked up.

• If you choose to file your own Notice of Transfer please remember that the “date of transfer” is the date that NKFH takes posses-sion of the vehicle. This is either the day the tow company picks up the vehicle or the day that you drop off the vehicle.

Step 3: Vehicle Pick Up or Drop Off after receipt of your signed Title in our office:

• Option 1: Vehicle Pick-Up:

Park your vehicle where it won’t be towed and/or acquire tickets.

Put your keys in the ashtray or glove box and lock the doors. (The towing company is able to open your door)

* Do NOT leave Title in the vehicle—Title must be in NKFHI Office before a pick up can be scheduled

*We recommend that you cancel your insurance after your car has been towed. *Please note: If the vehicle isn’t accessible to the tow company on the agreed upon dates and location, you will be charged for the Dry-Run Fee ($85) prior to having a second tow truck dispatched. If the vehicle is at a service station and parts are missing, your car could be rejected. Please ask mechanics/service station personnel to leave your car totally intact.

• Option 2: Vehicle Drop Off — If you choose to drop off your vehicle, it MUST BE RUNNING with Current Registration and Safety Check

Kidney Cars Office-Honolulu: 1314 S. King Street # 722 Honolulu, HI 96814

*Please DO NOT Leave Vehicles in parking area after our business hours*

• Drop Off Hours: Monday thru Friday: 8:30am-4:30pm or Saturday: 9:00am-3:00pm

• Park in empty lot on Akoko Street next to the Interstate Building. Please lock the doors and bring keys to the office,

*Make sure you remove all personal items from the car. Also, ensure that you remove anything that identifies you.

(i.e. the vehicle manual with your name on it, old registration cards, etc.)

Things to Remember:

- Specialty and Veteran Plates: If you have specialty plates and you want to keep them, you will have to go to the DMV to have generic plates issued and

put on the vehicle prior to the donation.

*Veteran plates are assigned to you and the DMV will not allow us to accept any vehicle with veteran plates. They must be removed prior to the

donation and replaced with generic plates.

- If Owner of Vehicle is Deceased: We would need to have the original title and owner’s notarized death certificate (the DMV requires it to be attached to the title). If someone other than the deceased wants the tax deduction, the title must be transferred prior to donation. If the donation is staying in the de-ceased name, an “Act 89” must be filled out by a next of kin, signed and notarized. NKFH has a notary on site. The forms are available at our office or at any

Satellite City Hall.

- Tax Deduction: As of January 1, 2005, the maximum tax deduction you can receive without needing notification of the Gross Selling Price (GSP) of the vehicle is $500. If the vehicle sells for more than $500 than you may claim the GSP as the deduction. NKFH will provide notification of the tax deduction

within 30-60 days of the sale. NKFH cannot ensure any selling price for any vehicle

Kidney Car Donation Instructions

Forms not to be reproduced in whole or in part without prior written permission of NKFH 3/7/2017

Where to Sign:

• There are two types of titles: Blue or Yellow (you should have ONLY one type)

� Blue Title: Below the odometer reading line, the owner(s) signature(s) and printed name(s) must appear on the signature line (one

signature per line).

� Yellow Title: Each listed owner must sign twice, once beneath each square block. If a lien holder is listed in the bottom box, then

the lien holder signs beneath the lower box. If the lower box reads “Same,” then each listed owner signs beneath the lower box.

� Notice of Transfer (N.O.T.): At least one owner must sign the N.O.T. (the white perforated portion on top). Please do not date or

submit the N.O.T. until the vehicle is physically picked up or dropped off.

- Titles must be free and clear of traffic violations and lien holders. If a lien holder appears on the title, they must sign off prior to donation.

- If your car has been salvaged by your insurance company, it must be stated on the title.

- The most recently issued title must be submitted (a duplicate title voids out the original).

NEVER SIGN THE BACK OF THE TITLE! If you are still confused, call 593-1515 ext. 1

Title and Notice of Transfer Information

Forms not to be reproduced in whole or in part without prior written permission of NKFH 5/20/2015

Yellow Title: Must be signed in 2 places

New Notice of Transfer

Do not date until

car is physically picked up

or dropped off. NKFH

will be happy to

submit the N.O.T to the DMV

by certified mail for

you.

Blue Title with Notice of Transfer

STOP!

STOP!

Kidney Car Assessment Form

Name/Names on Title:__________________________________________________________________________________________________

Address:_____________________________________________________________________________________________________________

City: _____________________________________________State:________________ Zip:__________________________________________

Day Phone:______________________________________________ Evening Phone:______________________________________________

VIN #: License :________________________

Year:_____________ Make:_________________________________________ Model:_____________________________________________

Type (Please circle the one that matches as it appears on the Title): 4DSD 4DSW 2DSD 2DSW 2DCV PKUP MPVH VAN PVAN

Color (Circle the one that best applies): Beige Black Blue Bronze Brown Burgundy Gold Gray Green Orange Pink Primer Purple Red Silver White Yellow

Transmission: Automatic Manual 4WD Cylinders: 4 6 8 Not Sure

Registration Expiration:________/________ Safety Expiration:________/________ Odometer Reading:_____________________

(month) (year) (month) (year)

Odometer Info: Accident Info: License Plate Info: Please check all that apply. Please check all that apply. Please check all that apply

Odometer is NON-Working (Odometer is broken) The vehicle was in an accident and repaired.

Odometer has turned over. The vehicle was in an accident and never repaired.

This is the actual miles. Title reads “Insurance Salvaged”.

Can car drive short distances? Yes No If No, What Repairs are needed to make car drivable: Please check all that apply.

Head gasket Major Body Damage Engine leaks Unsure

Transmission Timing belt Electrical issues Other ______________________________

Radiator Fuel system Ignition/Starter None

Brakes Water pump Cracked/Chipped Glass — If yes, how big?________________________

Condition Info: Please circle the number that applies: [5=Like New 4=Works “As Is” 3=Requires Minor Repairs 2=Requires Major Repairs 1=Must be replaced entirely] Best Worst Best Worst Best Worst

Battery: [ 5 4 3 2 1 ] A/C: [ 5 4 3 2 1 ] Seating Surface: [ 5 4 3 2 1 ]

Transmission: [ 5 4 3 2 1 ] - Does A/C blow warm air? Check box if yes. Interior Condition: [ 5 4 3 2 1 ]

Engine: [ 5 4 3 2 1 ] Paint: [ 5 4 3 2 1 ] Overall Car Condition: [ 5 4 3 2 1 ]

Tires: [ 5 4 3 2 1 ] Rust: [ 5=None 4=1-10% 3=11-30% 2=31-50% 1=>50% ]

Additional Comments: _________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

Forms not to be reproduced in whole or in part without prior written permission of NKFH 3/7/2017

Plates are in Storage.

Military Stickers.

Veteran or Specialty

- If yes, remove before pick up - If yes, transfer or store before pick up

Option - Drop Off at Kidney Cars Office: Honolulu **By approval ONLY**

Address: 1314 South King Street # 722

Drop Off Hours

• Monday thru Friday: 8:30am-4:30pm

• Saturday: 9:00am-3:00pm

Park in empty lot on Akoko Street next to the Interstate Building.

• Please lock the doors and bring keys to the office.

• Please do not leave car

outside of business hours

Forms not to be reproduced in whole or in part without prior written permission of NKFH 10/26/2015

Thank you for making your car a Kidney Car!

Car Location Information

Option - Pick Up: *Please remember to remove all personal items from car before pick up.* Check here if the address is the same as the Donor Information/Mailing Address:

Other: Street Address:____________________________________________________________________ Zip:____________________________

Contact Person (CP):___________________________________________________ Contact Phone #:______________________________________

*If vehicle isn’t accessible to the tow company on the agreed upon dates and location, you will be charged for the Dry-Run Fee ($85) prior to having a 2nd tow truck dispatched. If vehicle is at a service station and parts are missing, your car will be rejected. Please ask mechanics/service station personnel to leave your car totally intact.

Date ready for pickup? _______— _______—_______

What hours of the day/night will you permit the tow company to tow the car? 24hrs 7am-5pm

Will your vehicle doors be locked? (we recommend locking your vehicle) Yes No

Where will you be leaving the keys to the vehicle? Ashtray Glovebox Contact Person Other:___________________________________

Will you permit the tow truck driver to drive the vehicle (they are insured)? Yes No

Does the CP want to be present during towing? Yes No (If, yes, may take longer to tow)

Does the CP want a call before pick up? Yes No

Can we leave a message and tow? Yes No

Are all four tires fully inflated? Yes No

Is the car on a steep incline? Yes No

DROP OFF OPTIONS: In order to be eligible for drop off: 1. Required Documents must be submitted to NKFH Office prior to drop off.

Required Documents 1. Completed NKFH Car Donation Forms (Hard Copy or Online Forms) 2. Signed Title and Notice of Transfer

- If NKFH is filing the N.O.T. for you, the date should be left blank or be dated when the vehicle is physically dropped off

3. Please remove all personal items prior to drop off 4. Prior approval from NKFH

*We are no longer able to validate parking in the building. Please park in the empty lot.

From H1 heading West

•Take Lunalilo Exit

•Turn left on Pensacola

•Turn Left on South King

•Turn Left by Interstate Bldg

•Park in Empty Lot on Akoko St

From H1 heading East

•Take Kinau Exit.

•Turn Right on Pensacola

•Turn Left on South King

•Turn Left by Interstate Bldg

•Park in Empty Lot on Akoko St

Name/Names (as it appears on the Title):_________________________________________________________________________

Mailing Address: ____________________________________________________________________________________________

City:_________________________________________________ State: _____________________ Zip:______________________ E-mail:_____________________________________ Phone: (Day): _________________ Phone: (Evening): _________________

*Primary donor is the person who's Tax ID # will be used when filing an IRS Itemized Tax From and must be listed as an owner on the Certificate of Title

Name of *Primary Donor: _____________________________________________ Social Security # :________-_____-___________

Please Read Carefully and Sign Below

I have donated my vehicle to the National Kidney Foundation of Hawaii (NKFH). I release ownership with the understanding that the vehicle will be sold to raise funds to fight kidney disease in Hawaii. My car is being donated free of any unpaid violations, fines or liens (including tow charges associated with the theft of my car) and will remain so prior to NKFH taking physical possession of it. If I am asking NKFH to tow my vehicle, I understand that the following conditions apply:

1. If my vehicle is cited or removed prior to NKFH’s tow, I understand that NKFH will not tow my vehicle until I pay all fees including a NKFH assessed Dry-Run Fee for Non-Pick Up.

2. I understand that if my vehicle is not accessible to the tow company on the agreed-upon dates and location, I must pay for the dry-run fee prior to having a second tow truck dispatched.

3. If my car is non-running and currently not drivable; the car MAY be required to have a minimum of four feet of clearance on all sides, be on pavement and have at least one end of the vehicle open for a tow truck to hook up.

I must also give NKFH a transferable, Hawaii State, non-defaced title. If I cannot produce a transferable title, NKFH may reject my donation. In order to receive a tax benefit, I must itemize my taxes. I understand that if I have already depreciated the value of my vehicle or received an insurance settle-ment for its value, I may not qualify for a tax deduction. I hold harmless and agree not to pursue any legal action against NKFH, its board of directors or agents for any loss or liability that may be incurred as a result of my donation. NKFH reserves the final right to refuse the donation of any vehicle.

I understand that the maximum tax deduction I can receive without needing notification of the Gross Selling Price of my vehicle is $500. If the vehicle sells for

more than $500, then I may claim the Gross Selling Price as the deduction. NKFH will provide notification of the tax deduction within 30 days of the sale. NKFH

cannot guarantee any selling price for any vehicle. It may take up to 60 days or longer to sell your vehicle and for you to receive notification of your tax deduction.

This letter also authorizes NKFH to pick up the following documents from DMV after donation, if needed: registration, title, certified copies of your notice of transfer (N.O.T) to NKFH.

□ I will file the Notice of Transfer (N.O.T.) — Please do not date or submit the N.O.T. until the vehicle has been physically picked up or dropped off.

□ No, I authorize NKFH to file the Notice of Transfer (N.O.T.). Year:____________ Make: __________________________ Type:____________________________

License #:______________________________ VIN # :_____________________________________________________________________________________________________

□ I understand that my tax deduction per IRS Regulations may be the standard $500 Car Donation Tax Deduction.

My signature below indicates acceptance of NKFH regulations for this vehicle donation and any future vehicle donations which I may designate to the NKFH upon the deliverance of my properly signed title.

Date: ___________________________ Signature:___________________________________________________________________________

Forms not to be reproduced in whole or in part without prior written permission of NKFH 10/26/2015

Donor Information and Disclosure