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2. 
4. * Your donation will be added to your water bill each month or you may make a one-time cash donation.
   * Your donation is tax deductible (as provided in section 170 of the Internal Revenue Code)
6. I pledge the following amount PER MONTH to be included in my utility bill:*

   1. $1.00
   2. $2.00

   1. $3.00
   2. $5.00

   1. $10.00
   2. $15.00

   1. $20.00
   2. $30.00
8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City
16. State
17. Zip*
19. Daytime Telephone:*
22. Thank You! Mesquite Library Greatly Appreciates Your Support!
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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