OBITUARY AND PHOTOCOPY REQUEST

Date of Request:  _________________________       Amount Due:             __________________
Date of Reply:     _________________________       Date Payment Rec’d: __________________
Patron Name and Address:

 

Telephone # and/or Fax #: __________________       Email Address: __________________
Items to be photocopied or # of photocopies made:

 

Obituary Request:

Name:                                                                          Date of Death:


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Reply to Patron (check as appropriate)

_____  The obituary/obituaries you requested have been copied and are enclosed.  The library charges $5 for each obituary.  Please send a check payable to the Berkshire Athenaeum for ____________.

_____  The item(s) you requested are copied and enclosed.  The library charges $5 for the first 5 pages and $.25 for each additional page.  Please send a check payable to the Berkshire Athenaeum for _____________.

_____  The item(s) you requested are NOT enclosed because we did not find it in our sources.

_____  Other _________________________________________________________________
______________________________________________________________________

Make check payable to:            Berkshire Athenaeum

Send Payment to:  
                                                Local History Department / Reference Department
                                                Berkshire Athenaeum                           
                                                1 Wendell Avenue
                                                Pittsfield, MA  01201-6385