Memorial Form

Memorial Form

Date:

Person(s) Memorial or Honor is for:

______________________________________________________________________________________
(Please print as you want to appear on bookplate and in newsletter)

Donor:    _____________________________________________________________________________
(Please print as you would like to appear on bookplate and in newsletter)

Donor address and phone number: 

_______________________________________________________________________________________________________

Name and address of person to receive memorial notice from library (limit 1)

_____________________________________________________________________________________

Choose memorial designation.    Adult ____ Juvenile ____ General ____

Total amount donated: ________

We strive to be good stewards of your donation which will allow the library to purchase additional materials for our collections. 

Any materials purchased will display a memorial plate. 

All donations will be listed in the library newsletter.