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ebster Public Library
Webster Plaza, 980 Ridge Road
Webster, NY 14580
(585) 872-7075  

 

GIFTS CHECKLIST

Date of gift:                                          Amount:                                    

Name and address of donor:  ______________________________________
_______________________________________
_______________________________________

 

Check appropriate area:  
  c Gift is a memorial donation
  c Gift is in honor of an individual or an event (e.g., anniversary, retirement)

Exact wording on bookplate: _______________________________________
_______________________________________

 
  c New “Webster Baby”: Baby’s first name:           _____   Date of birth:               

  c Please add an engraved plate to the library's wall plaques at a cost of $10.  If you select this option, please add $10 to your contribution.  Please indicate your preference and print the spelling of the person's name.

                  c Memorial Gift in the name of : __________________________

                  c In honor of:  ________________________________________

Subject, area of special interest, or age-level materials (e.g., children's, teen, audiobooks): ________________

Name and address of family or honoree to be notified: _________________________________________
_________________________________________

OFFICIAL STAFF USE ONLY—ATTACH ALL RELEVANT CORRESPONDENCE
Give this form and donation directly to the Library Director  
Information taken by___________________
 Date family or honoree notified_________
Date donor acknowledged_______________ Material available for loan and family notified to borrow_______  

Librarian responsible: LW  PL  DK  AF  OSD (circle one)                 c  Undesignated donation  

Webster Public Library
 Webster Plaza, 980 Ridge Road, Webster, New York 14580 USA
Telephone: 585-872-7075    Web site: www.websterlibrary.org
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