Please list the name(s) of the person or persons you wish to honor with your contribution.   Amount of donation: $___________________________
Donor Information:   NAME(S):________________________________________________________ STREET ADDRESS:________________________________________________ CITY:________________________ STATE:___________ ZIP CODE:________ E-MAIL ADDRESS:_________________________________________________ Please print this form and include it with your check made payable to the Norfolk Public Library. Your contribution is fully tax-deductible.
Mail to:	Norfolk Public Library 1155 Pineridge Road Norfolk, Va 23502 ATTN: Direct Donations THANK YOU!