Memorial Gift Form

Memorial Gift Form

Date: __________________

Name of person being honored:

 __________________________________

Name of person making Gift: 

_____________________________________

Address: ____________________________Town: _______________

State: _________________ Zip: ________________

Amount of Gift: $___________ Check #: ____________ Phone: _______________

_____________________________________________________________________

Acknowledgment of this gift goes to:

Name: ______________________________________________________________

Address: ___________________________ Town:_______________

State: ________________ Zip: ___________  Phone ____________

This gift should be: Used to buy a book or Used as needed  (Circle Preference)

**All donations are welcomed, but in order to have an acknowledgment label placed inside a book and have an acknowledgment card mailed, a minimum gift of $25.00 is necessary.
    You may print this form and mail it with your donation to Kountze Public Library, 800 S. Redwood Avenue, Kountze, Texas, 77625
     Please note that "accounts" for memorials are not set up in advance when the library is designated
as a recipient of memorial gifts.
__________________________________________________________________