Project Depot 

 We need your help to restore this historic building.  All contributions made on this form will go directly to restoring to the depot and may be tax-deductible..  Please print this page out, and send it in with your check payable to the Coles County Historical Society.

Contributions: (PLEASE PRINT)

 

Contributor's Name_______________________________________

 

Address* _____________________________________

 

City ____________________    State ________  

 

 Zip*____________

 

Country ____________________   

 

Amount $________________

 

 I wish to make this in memory of:____________________

 

 Making Me/Us a:

 

___  Golden Spike Society-$10,000+

___  Superintendent - $5,000+

___  Trainmaster - $1,500+

___  Conductor - $800+

___  Engineer - $500+

___  Brakeman - $200+

___  Fireman - $100+

___  Gandy Dancer - $50+

___  Other amount

___  I do not wish to be recognized

 

Address to:

First Mid-Illinois Bank & Trust

c/o Dave Robinson

1515 Charleston Avenue

Mattoon, Illinois 61938

 

  

 
   
*  The ONLY reason we ask for these is to be able to send you a receipt for tax purposes.  You only need to supply them if you wish to receive the receipt.