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Please print, complete and mail this memorial donation form with your check, payable to the David A. Howe Public Library, to:

David A. Howe Public Library
155 N. Main St.
Wellsville, NY 14895

 

Enclosed is a contribution of $

This gift is made in

memory of     honor of

It is given by

           Title 
            Name 
    Organization (if applicable) 
  Street Address 
 Address (cont.) 
            City 
	   State   Zip Code 
           Phone 
          E-mail

Please send an acknowledgement of my gift to

           Title 
            Name 
    Organization (if applicable)
  Street Address 
 Address (cont.) 
            City 
  	   State Zip Code
 Additional information
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________

Thank you for your generosity.
All contributions are tax-deductible in the U.S. The David A. Howe Public Library is recognized as tax exempt under section 501(c)(3) of the Internal Revenue Code.

Revised: February 22, 2008

David A. Howe Public Library, 155 N. Main St., Wellsville, NY 14895
Phone: 585-593-3410   Fax: 585-593-4176   Email: wellsville@stls.org