J.C. Clegg Public Library
137 4th St. North
Central City, IA 52214

Date______________________

Title____________________________________________________________________

Book__________  Periodical__________  Other___________

Author__________________________________________________________________

Publisher________________________________________________________________

Request initiated by________________________________________________________

Address_________________________________________________________________

City________________________________State___________Zip__________________

Telephone_______________________________________________________________

Do you represent:
1. Yourself_____________________________________________________

2. An Organization (name)________________________________________

3. Other group (name)____________________________________________

1. To what in the work do you object? (Please cite specific pages)



2. Did you read the entire work?__________  If not, what parts did you read? 
_____________________________________________________________________

3. What do you feel might be the result of reading this work?



4. What do you believe is the theme of this work?


5. Are you aware of the judgments of this work by critics?



6. What would you like your library to do about this material?



Do not lend it to my child.  __________________
Return it to the Board of Trustees for reevaluation._____________________

7. Are you usually able to find what you want in the library? ___________

If not, what materials would you like to be able to find in the Library collection?









Signature

____________________________________