Memorial Gift Form   

* This form can be printed and returned to the library by mail or in person.

Date: __________________

Name of person being honored: __________________________________

Name of person making Gift: _____________________________________

Address: ____________________________________ Town: _______________

State: _________________ Zip: ________________

Amount of Gift: $___________ Check #: ____________

_____________________________________________________________________

Acknowledgment of this gift goes to:

Name: ______________________________________________________________

Address: __________________________________ Town:_______________

State: ________________ Zip: ___________

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 plate placed inside a book and have an acknowledgment card mailed, a minimum gift of $25.00 is necessary.

__________________________________________________________________
(Please do not write below this line)

Title of Book being placed:____________________________________________

_________________________________________________________________

Date Placed:________________________

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