CERTIFICATE OF PURCHASE (keep for your records)

ITEM: ________________________
ENGRAVING ON THE PLAQUE TO READ:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
PAID FOR BY:__________________________________________________
ADDRESS:_____________________________________________________
IN THE AMOUNT OF: ___________________________________________
DATE: _______________________________
THANK YOU FOR YOUR CONTRIBUTION TO ODEBOLT'S FUTURE!

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -   CUT - - - - - - - - - - - - - - - - - - - - - - - - -
(Cut on the line above and send an enclosed check and the form below to:)

ODEBOLT MEMORIAL PARK WALK
ATTN: Ron Rex
406 W. Hwy.
Odebolt, IA 51458

CERTIFICATE OF PURCHASE (send in this portion)

ITEM: ________________________
ENGRAVING ON THE PLAQUE TO READ:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
PAID FOR BY:__________________________________________________
ADDRESS:_____________________________________________________
IN THE AMOUNT OF: ___________________________________________
DATE: _______________________________