Just as the Dominy family made our present library possible 100 years ago , now it is our turn to leave our legacy for future generations. It is a precious opportunity to make a lasting difference in the world. This donation is an affirmation of the need to ensure the future of our library as a center of education and enlightenment for individuals and families in the 21st century.

The gifts made to the “Dominy Memorial Library: A New Chapter” campaign are deductible to the full amount allowable under the Internal Revenue Service regulations.

My/Our total tax-deductible gift is ___________


This gift will be paid in one payment:

	____ over one year

	____ over two years

	____ over three years

	____ other (please indicate) ___________________________

Please use my/our gift toward:

________Building costs for our renovated and expanded library

________A room, area, or item … please specify below

We want our gift used for_____________________________

Payment Method:

Expected date of one-time or initial payment________________

Expected payment schedule: ____ annually, ___ semi-annually, ___quarterly or other ____.

(Please send me reminders: yes___ no___ )

Expected form of payment: cash __, stocks __, bonds __, other assets __. (please specify)

If enclosing a check, please make it payable to:

Prairie Lands Foundation
P.O. Box 260
Fairbury, IL 61739

* Please write “For Dominy Memorial Library” on the memo line.

Gift Terms:

Names of donors will be published but not specific amounts. However, please check here if you want your gift to be anonymous.

Name(s) ______________________________	Signature(s) ______________________________
______________________________	______________________________

Dominy Memorial Library	Phone (815) 692-3231
E-mail: Dominylibraryanewchapter @yahoo.com	Fax (815) 692-3503