Required fields are marked with asterisks (*)

Bench Donation Program

Donations can be made to install a new bench in our municipal parks. The bench donation can be utilized as a form of remembrance of a loved one, celebration of a birth, honouring a retiree or any commemorative event and includes an engraved plaque installed on the bench.

The Municipality of Leamington is a “non-profit” organization and meets the requirements by Revenue Canada for the issuance of income tax receipts.

Donor First Name

Donor Last Name

Street Address

City

Postal Code

Phone Number

Type of Contribution

Bench Donation $1,500 per bench (plaque included)

Proposed Site

Please Issue a Tax Receipt

Yes

Signature

Clear

Date

Payment Options

Print Form and Submit with Cheque

Online Payment with Credit Card

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act, 2001 P.S.O. c45, and will be used for the purpose of program development and operation. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, ON, N8H 2Z9. Telephone: 519-326-5761.

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