Make Checks Payable to:   Friends of Hebert Public Library               

                                                                                            Please feel free to purchase and donate any

                                                                                            item on our Wish List for your Memorial.    

                                                                                                                                                                                DATE____________________

MEMORIAL / GIFT  FORM                                          Computer    _______

                                                                                                                                                                                Letter           _______

PLEASE PLACE A BOOK IN:                                                                                                                            Plate             _______

_______MEMORY OF                (CHECK ONE)         ________HONOR OF                                                                                                                                                                                                                      

____________________________________________________________________________________________________________

NAME OF PERSON BEING HONORED

NAME / ADDRESS OF PERSON(S) TO RECEIVE NOTICE OF THIS GIFT:

NAME: ____________________________________________       NAME: _____________________________­__________________

ADDRESS: _________________________________________      ADDRESS: _____________________­_______________________

                      _________________________________________                          ____________________________________________

RELATIONSHIP TO PERSON:                                                              RELATIONSHIP TO PERSON:

                      _________________________________________                         _____________________________________________

AMOUNT OF THE GIFT YOU WANT TO PLACE: ____________________________                     CHECK #_________________

NAME / ADDRESS / PHONE NUMBER OF DONOR(S):

NAME: ____________________________________________    NAME: ________________________________________________

ADDRESS: _________________________________________   ADDRESS: _____________________________________________

                     _________________________________________                      _____________________________________________

PHONE: ___________________________________________     PHONE: _______________________________________________

THE SUBJECT(S) OF THE BOOK(S) I WOULD LIKE PLACED IN THE LIBRARY:

____________________________________________________________________________________________________________

_______   I HAVE NO PREFERENCE FOR THE SUBJECT MATTER                                                ________ TECHNOLOGY FUND DESIGNATION

                                                                                                SIGNATURE_____________________________________________________

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