Memorial Form

A donation to the library is a thoughtful gift that will continue to be used by people in the community.

All contributions are tax deductible.

Please print:

Date____________________

Enclosed is a contribution in the amount of $__________________________

In MEMORY of ______________________________________________________________________

OR

In HONOR of ________________________________________________________________________

OR

In CELEBRATION of _________________________________________________________________

The contribution shall be used:

___ As needed for general library materials or programs

___ For the purchase of a book and bookplate ($15 minimum contribution)

Please indicate a location, if desired:

___ Main Library - Adult     ___ Main Library - Children's    ___ Main Library - Outreach

___ Gibsonburg Branch      ___ Green Springs Branch         ___ Woodville Branch

Send notification of gift to: 

Name_________________________________________________________________________

Address_______________________________________________________________________

City, State, Zip _________________________________________________________________

From:

Name_________________________________________________________________________

Address_______________________________________________________________________

City, State, Zip _________________________________________________________________

This form may be mailed along with your contribution to:

Birchard Public Library Administration 
423 Croghan Street 
Fremont, OH 43420