Gift to the Wilmington Memorial Library Memorial Fund |
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| Date: | _____________________________ |
| I, | ________________________________________________________ |
| (your name) | |
| ________________________________________________________ | |
| (your address) | |
| Hereby donate | $ ____________________ |
| (tax deductible amount) | |
| Payable to | Wilmington Memorial Library |
| Bookplate Inscription: | |
| In Memory of _____________________________________________ | |
| or In Honor of ____________________________________________ | |
| Please state occasion (anniversary, birthday, etc.) | |
| _______________________________________________________ | |
| Please check the collection that you would like to have the book selected for: | |
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| Please send letter of acknowledgment to: | |
| Name ___________________________________________________ | |
| Address _________________________________________________ | |
| _________________________________________________ | |
| Please print and fill out the form; then mail it to |
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| Wilmington Memorial Library 175 Middlesex Avenue Wilmington, MA 01887 |