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 ____________________________________________________
