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Please print this page out, fill in the information, and
mail with your check to:
J. R. Huffman Public Library
Route 5, Box 2140
Hemphill, Texas 75948-1036
Donor's Name: ____________________________________________
Donor's Address: __________________________________________
Donor's City, State, Zip: _____________________________________
Donor's Telephone: (______) ________________________________
This donation is for: __General __Birthday
Book Club __In Memory Of __Other
If "Other", please specify: _____________________________________
________________________________________________________
Honoree: _________________________________________________
Honoree's Address: _________________________________________
Honoree's City, State, Zip: ____________________________________
Honoree's Birth Date: (If for Birthday Book Club) _____/_____/_______
Donation Amount: $_________
Birthday Book Club: $20. Plaque:
$100. Inscribed Book Plate: $20.
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