GIFT NOTE              

Chuck Graves,  please accept $31.00 as my gift to  you.


Signature_______________________________________________________

If you are giving for yourself put your name and address below;
If you are giving for another, put their name and address below:

PLEASE PRINT EVERYTHING BELOW
IT DOESN'T HELP EITHER OF US IF I CAN'T READ WHAT YOU WROTE

Name_______________________________________________________

Street Address ________________________________________________

Additional Address_____________________________________________

City______________________________ State_______ Zip ____________

If gift renewal reminder is to be sent to person above check here __________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If gift renewal reminder is to be sent to person below check here __________
and fill in below information:
(Thank You note and Giver Number will be sent to both addresses)

Name________________________________________________________

Street Address _________________________________________________

Additional Address _____________________________________________

City_____________________________________ State_____ Zip _______

If you wish your Giver Number and Thank You note to be emailed to you

enter your email address here ______________________________________

Mail to:  Chuck Graves  P O Box 422,  Barre, Vt  05641
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