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[[preprinted]]
3635

[[underlined]]RETURN THIS BY MAIL, PREPAID, TO THE SMITHSONIAN INSTITUTION, WASHINGTON, D.C.[[/underlined]]

Date [[blank line]] 1880.

1. Name of Establishment [[blank line]]
            
[[blank line]]

2. Post Office Address--Town [[blank line]] State [[blank line]]

3. When Established [[blank line]]

4. Value of Buildings and Property [[blank line]]

5. Permanent Fund or Endowment [[blank line]]

6. Annual Income [[blank line]]

7. Number of Volumes now in Library [[blank line]]

8. Average Annual Increase of Library [[blank line]]

9. Use of Library.  By whom and how much used [[blank line]]

10. Publications made by the Library [[blank line]]
(Send printed list if there is one.)

[[blank line]]

11. Volumes of Smithsonian Contributions to Knowledge (quarto) in the Library. (Specify the particular volumes)[[blank line]]

12. [[ditto for "Volumes of Smithsonian"]] Miscellaneous Collection (octavo) in the Library. [[ditto for "(Specify the particular volumes) [[blank line]]
 [[blank line]]

13. [ditto for "Volumes of Smithsonian"]] Annual Reports (octavo) in the Library.  [[ditto for "(Specify the particular volumes)"]] [[blank line]] 
[[blank line]]

14 Specimens or Collections received from the Smithsonian Institution [[blank line]]

15. Best mode of forwarding large parcels to the Library [[blank line]]

16. Names of Officers: President [[blank line]]

Secretary [[blank line]]

Librarian [[blank line]]

17. Name of Representative in Congress [[blank line]]

(Signature of Person filling up this Blank.) [[blank line]]
[[/preprinted]]
   
                                                             








  

Transcription Notes:
This is a blank form with blank lines all right justified except those in item 16 and first line in item 17. The second and third line in item 10 is indented, as are the second lines in items 1, 11, 12 and 13.