LIBRARY NAME
==================================================================

ACKNOWLEDGEMENT OF RECEIPT


Date: <DATE>

Title: FIELD<LIBRARY:TITLE>
Author: FIELD<LIBRARY:AUTHOR>
Barcode #: FIELD<LIB_COPIES:BARCODE>

Issued To: FIELD<BORROWERS:NAME>
Issued On: FIELD<LOAN:LOANDATE>
Due Date: FIELD<LOAN:DUEDATE>


By my signature below I acknowledge receipt of the above-specified 
library item.

Signature for Library Item Received: __________________

Printed Name: ______________________________________

This item remains the property of ENTER_LIBRARY_NAME. Loss, damage, 
or need for repair should be reported to the LIBRARY Office Coordinator.



Item RETURNED


Date: _____________________________________

Condition: _____________________________________

Signature for Item Returned: _______________________________________

Printed Name: _________________________________________

Received by: ____________________________________________