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Milton House Project Gift

                To support efforts to preserve the Milton House for future generations, I / we hereby make a contribution in the following manner:

_____    Full payment of $__________enclosed.

_____    I / we wish to make contributions of securities, property, planned gift or other type.  (Please have a Historical Society representative contact me.)

Naming rights opportunities are available.  Please contact the Society office at (608) 868-7772.

All Payments should be made to the Milton Historical Society.  Your contribution is fully tax deductible in accordance with IRS regulations.

NAME ___________________________________________________________________

ADDRESS ________________________________________________________________

CITY ____________________________________________________________________

STATE _________________________________   ZIP _____________________________

PHONE __________________________________________________________________

DATE ___________________________________________________________________

SIGNED _________________________________________________________________

 Thank you for your support and generosity.

Please mail this form to:

Milton Historical Society

PO Box 245

Milton, Wisconsin  53563

Phone: 608-868-7772   Fax: 608-868-1698