Jersey County Historical Society Monetary Donation
To make a monetary donation, please print and complete this form, and mail it and your check (made
payable to the Jersey County Historical Society) to:

                                                          Jersey County Historical Society
                                                          601 N. State Street
                                                          Jerseyville, Illinois 62052

Your Name:  _______________________________________________________________

Address:  _________________________________________________________________

Amount:  _________________________________________________________________

I would like to make a monetary contribution to the Jersey County Historical Society and would like this
money used for:  
(If you have a preference, please check one of the following options. If you do not make
a choice, the money will be used for the upkeep of our buildings and grounds, etc.)

___ The Cheney Mansion                                        ___ The museum's military room

___ The Lone Star School                                        ___ The museum's domestic rooms

___ The McAdams log cabin                                   ___ The museum's transportation room

___ The Union Forest Church                                ___ The Jersey County Historical Society

___ The Genealogy Research Center                    ___ Other _______________________________


Please use this money as a memorial fund in the memory of _________________________________.

  If your donation exceeds $25, we will mail you a receipt, which can be used for tax purposes.

          Questions? Call us at 618-498-3514 or email us at webmaster@jerseyusa.net.