South Park Township Library Memorial Book Form

In Memory Of

Donor’s name, address and phone number

Presented by

(Please word this the way you wish it to appear on the bookplate.)

Send acknowledgement to

Suggested subjects

Or check here if you would like the Library to make the selection._______

Make checks payable to: South Park Township Library

Donation: $__________________________________________

(suggested minimum: $15.00)

Mailing address: South Park Township Library

2575 Brownsville Road

South Park, PA 15129