Please print this Form and Send along with items to the address below:

Chesterfield District Chapter, S.C.G.S. Post Office Box 167 Chesterfield, South Carolina 29709

2004 DONATION FORM

Name ___________________________________  Address ____________________________________ City _________________________  State _____  Zip ___________  Telephone (     ) _______________ Email Address ___________________________________________  Date ________________________

Money (   )         Genealogical Books (   )         Genealogical Periodicals (   ) CD Roms (   )         Microfilm (   )         Microfiche (   )         Newpapers (   ) Ancestor Charts (   )         Family Group Sheets (   )         Family Histories (   ) Bibles (   )         Photographs (   )         Scrapbooks (   )         Office Supplies (   ) Other (   )

Please make checks payable to Chesterfield District Chapter, S.C.G.S.

List items or item groups and how many of each below.

_________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________ _________________________________        _________________________________

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