| Complete this form, print it out, and send it with your check for $2.00 to: | |
| Minneapolis Public Library 519 Delia Minneapolis, KS 67467 | |
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| Payment Information | |
| Amount of Check | |
| Query Information | |
| Enter exact name: | |
| Enter exact death date: | |
| Enter newspaper date: | |
| Customer Information | |
| First Name | |
| Last Name | |
| Address | |
| City | |
| State | |
| Zip Code | |
| Phone | |
| Fax | |