Old St. Rose of Lima Church Restoration Project

For all donations, please fill out this section

Your name: Mr/Ms/Mrs _____________________________________________________ Donation amount $ _______________

Your address: ___________________________________________ City, State & ZIP Code: _______________________________

Daytime phone (          ) ____________________________________  Evening phone (          ) _______________________________

For donations of $175 or more, please fill out the following information to be printed on the brick:

Your listing must fit within the twenty spaces allowed on each of two lines. If you would like assistance, please contact us at (805) 584-4453. Examples of listings include:

The Sharpe Family
David,Sarah,Tim,Jean

In Memory of
Susan Ann Jones

Bob and Mary Smith
and Family


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Please make your check payable to "RSRPD-Church Restoration"
and mail or bring it to: Rancho Simi Recreation and Park District
Attn: Colleen Janssen, 1692 Sycamore Drive, Simi Valley, CA 93065-3728
Donations to the Old St. Rose of Lima Church Restoration Project are tax deductible.  Tax ID #95-2215284