Quinte-Kin Memorial Donation Form

Quinte Kin Home
Please print out and complete this form.

7th Town Historical Society
MARILYN ADAMS GENEALOGICAL RESEARCH CENTRE TRUST FUND
Box 35, 528 County Road 19, Ameliasburg, Ontario, Canada K0K 1A0
(Registered Charity BN 89191 7577 RR0001)

A DONATION HAS BEEN MADE IN MEMORY OF:
FROM:
ADDRESS:
CITY:	PROV. / STATE:	POSTAL CODE:

An entry will be made on our memorial wall at the Marilyn Adams Genealogical Research Centre
and online at www.quinte-kin.com

Please complete the above and take the top half to the funeral home, or mail to the family.
Complete and send the following, with your cheque or international money order made payable to the
7th Town Historical Society, to:

7th Town Historical Society
MARILYN ADAMS GENEALOGICAL RESEARCH CENTRE TRUST FUND
Box 35, 528 County Road 19, Ameliasburg, Ontario, Canada K0K 1A0
(Registered Charity BN 89191 7577 RR0001)

Enclosed is a donation to the TRUST of $ __________ (Under the Canada Revenue Agency ten year rule)
IN MEMORY OF (DECEASED):
FROM:
ADDRESS:
CITY:	PROV. / STATE:	POSTAL CODE:
SIGNATURE: (Required by Canada Revenue Agency under the 10 year rule)

FOR OFFICE USE ONLY: Date ________________________ Receipt Mailed ____________________