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2. DONAR INFORMATION:
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
18. GIFT INFORMATION:
20. Gift Amount:
21. Gift Format:

    1. Check
    2. Cash

    1. Item
23. Title:
24. Author:
26. Item Format:
    -- Select One --BookAudiobookDVDBlu-RayeAudiobookeBookLarge Print
27. Item Location:
    -- Select One --Charles R. Jonas LibraryFlorence S. Shanklin Branch LibraryWest Lincoln Branch Library
31. MEMORIAL INFORMATION:
33. This gift is given in:

    1. Honor of

    1. Memory of
35. Name of Person/Group

    Please enter name exactly as desired for book plate

39. GIFT NOTIFICATION:
41. Name
43. Address
45. City
46. State
47. Zip Code
49. Phone Number
50. Email Address
52. Please notify the following for first loan (optional):
54. Name
56. Address
58. City
59. State
60. Zip Code
62. Phone Number
63. Email Address
65. Library Card Number:
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field