DONATION FORM
Yes – I want give to Pocahontas County by donating to our public libraries:
Amount ___$10 ___$25 ___ $50___ $100 ___Other amount - $_____
Name_____________________________________________________ Phone_______________
Address________________________________________________________________________
My contribution is in honor/memory of: ____________________________________
Please earmark my contribution for: ___General Fund ___Green Bank Building Fund
___Hillsboro Renovation Project
____ Other Purpose (Please specify) ________________________________________________