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Perry Public Library

Request for Withdrawal of Material

 Author         _______________________________________________________

Title              _______________________________________________________

Publisher     _______________________________________________________

1. How was this material brought to your attention?

 

2. What objections do you have to the material?

 

3. Did you read, see, or hear the entire material? If not, what parts?

 

4. What do you feel might be the result of reading, seeing, or listening to this material? Did it have this effect on you?

 

5. What reviews of this material have you read?

 

6. In your opinion, is there anything good about this material, any redeeming quality?

 

7. What would you like the Library to do about this material?

 

8. Comments (use back of this form if necessary):

 

Date                                    ____________________________________________

Signature                            ____________________________________________

Telephone                          ____________________________________________

Address                              ____________________________________________

Complainant Represents ____________________________________________


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     Last updated April 17, 2007