Old Republic General Fund
Ϝ  Yes, I would like to make a tax-deductible contribution to the General Fund.

Ϝ  Cupola Level.......$10,000 and above

Ϝ  Cornice Level.......$1,000-$9,999

Ϝ  Column Level.......$500-$999

Ϝ  Cornerstone Level.......$499 and below

Challenge Grant Fund
Ϝ  Yes, I would like to make a tax-deductible contribution to the Challenge Grant Fund.


Amount Enclosed:$___________________


______________________________________________________________
Name

____________________________________________________________
Address

________________________________
Phone

Please print and mail to:
Historic New Carlisle, Inc.
P.O. Box 107
New Carlisle, IN 46552
Thank you for your support!