Memorial/Donation to the Olean Public Library


Your contact information.

Name:
Address:
City: State: Zip:
Phone:

Contact information for individual or group being honored.

Name:
Address:
City: State: Zip:
Phone:

Donation amount $

How do you want your donation listed? In Memory of   In Honor of

Name of Honoree:

Would you like to specify how your donation is used? Yes No
For example, you could request your donation be used for a particular program, item or title, or for general use such as a subject, book, video, furniture, etc. If yes, please indicate in the space below how you would like your donation to be used.

Do you want to examine this item before it is placed into circulation? Yes No


Print this completed form and mail with check payable to:
Olean Public Library
134 N 2ND ST
OLEAN NY 14760-2583


Acknowledgement for tax purposes will be sent to the donor.

©Olean Public Library, 2004. Print button script is written by Eric (Webcrawl@usa.net) for full source code.