Memorial Donation Form

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MEMORIAL DONATION FORM
***Make checks payable to the Friends of the Henderson County Library***
Date: ____________
Amount donated: $______________
(Minimum of $20 is required for material purchases)
Donor’s name(s): ________________________________________________
Donor’s Address: ________________________________________________
In Honor/Memory of: ______________________________________________
Circle one
Any extra text on plate: ____________________________________________
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Letters of acknowledgement to:
Name: __________________________________________________________
Address: ________________________________________________________
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Name: __________________________________________________________
Address: _______________________________________________________
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Topics or specific titles: ___________________________________________
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