Amount $_________________ Date________________
In Memory of _____________________________________________________________________________________
How would you like the bookplate to read? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Given by __________________________________________________________________________________________
Address ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Send card to ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__ No thanks. A card has already been sent.
Special notes: (I.e. “Please buy a book” or “Use for building fund”)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__ Please check here if you do not need an acknowledgment.
Mail form: Allegany Public Library
90 W. Main St.
Allegany, NY 14706