Contact Name *

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Description of Content *

Edition if appropriate, quality of book, completion of pages verified, type of original source: fiche, film, book, or digital

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DONATION (expectation source not returned, and or preserved in the salt mines) or LOAN (source needs to be returned to donation library)

Reason for Divestment

Reason why LLMC should digitize and preserve this content

Name of Institution/Individual for Acknowledgment