Enclosed is my donation of $____________ to be used as
_______ Unrestricted gift _______Special Project (Specify)
This gift is from:
Name_________________________________________________________________
Address_______________________________________________________________
City______________________________________State__________Zip____________
Make checks payable to: Birchard Library Association Foundation
This form may be printed and mailed, along with a check, to
Birchard Library Association Foundation, c/o Birchard Public Library
423 Croghan Street Fremont, OH 43420