Ben Caudill Camp #1629
Civil War Memorial Historical Monument
Veteran Inscription Order Form
Veteran Data Sheet

Contact Information of Person Purchasing Inscription on Stone
Purchase Price: $20.00

Name: _______________________________________________________

Mailing Address________________________________________________________

Email__________________________________________________________________

Phone_________________________________________________________________

Date Money Received/Check #/Money Order/Cash Receipt______________________

Date Inscription Ordered_____________________________________________________

Family notified by: phone____email_____letter____in person____

Soldier’s Name/Rank/Unit/Comments_____________________________________________________________

______________________________________________________________________________________________

Note: no more than 20 letters per line with 4 lines, information will be placed randomly on the 36x36 stone.

(Pictures of the 8’8” by 10’ Historical Marker Located at Pound Gap (Rt. 23) on Va.-Ky. border)

(Send check to: Secretary Danny Taylor, 730 Walters Branch, Isom, Ky. 41824)