Donations and Memorials

MARY H. WEIR PUBLIC LIBRARY
3442 Main Street
Weirton, WV 26062
(304) 797-8510

DONATION AND MEMORIAL FORM

DATE ____________________________

FORM COMPLETED BY____________________________

_____Memorial Book Prepaid ______Yes ______No

_____General Fund Amount _____________________

_____In Honor Of (Special Occasion) Ck Number _______________________

Cash _______________________

Make check payable to Mary H. Weir Public Library.
A Donation of less than $20.00 will be placed on the general fund.

Donation from: Name _____________________________________________

Address _____________________________________________

_____________________________________________

Telephone _____________________________________________

List request as it should read on the Book Plate:

In Memory of __________________________________________________

In Honor of __________________________________________________

Request made by __________________________________________________

Subject to be left to the discretion of the Library Yes _______

Subjects Suggested: ________________________________________

Title Suggested: _________________________________________

Author Suggested: _________________________________________

Donation of book by Patron: Title: ____________________________________

Notification to be sent to:

Name ____________________________________________________

Address ____________________________________________________

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