Civil War Memorial Historical Monument
Data Sheet
Contact Information of Person Purchasing Name
Purchase Price: $20.00
Name: _______________________________________________________
Mailing Address________________________________________________________
Email__________________________________________________________________
Phone_________________________________________________________________
Date Money Received/Check #/Money Order/Cash Receipt______________________
Date Ordered_____________________________________________________
Family notified by: phone____email_____letter____in person____
Soldier’s Name/Rank/Unit/Comments_____________________________________________________________
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