Statement of Concern Regarding Library Materials

Anyone from Miami County with a concern over library materials may fill out a Statement of Concern. Name and address, including street and city, must be included.
Please complete the following information:

Are you a Miami County Resident?

Yes

First

Last

Date:

Address

City/Town

State/Province

ZIP/Postal Code

Title of Item:

Author

Publisher:

Format

Book

DVD

Music CD

Other…

Do you represent yourself?

Do you represent an organization? (Please identify)

Did you read, listen to, or view the item in its entirety?

If not, what parts did you read, listen to, or view?

What brought this resource to your attention?

What is your objection to this item? Please be specific and cite pages or scenes.

What harmful effects do you feel might be the result of library having this item?

Overall, do you believe there is any value in this resource?

What would you like the library to do about this item?

Additional comments:

Signature

Sign above

Date:

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