Please download and send this application with check or money order with all information requested to:

Lewiston Auburn Veterans Council Inc.

Gerry N. Cain, Treasurer

53 Oxbow Drive, Lewiston, Maine 04240-2137

Veterans Memorial Park Name Application

To have a veterans name engraved on a “Memorial Stone” at the Veterans Park, the individual must be a veteran or currently active in the military, reserves or national guard. Along with this application you must send a copy of your DD214 or WD AGO 53 55 (WWI & WWII).

To expedite the process a photograph in military uniform should be attached.

A check or money order for 30.00 (engraving fee) must be enclosed.

No items are returned so please make copies.

In the case of fraudulent applications the 30.00 fee will be kept to cover administrative cost.

Please PRINT all information

First Name: ____________________________________

Middle Initial: __________________________________

Last Name: ____________________________________

Branch of Military Service

Army: _____ Marines: _____ Navy: _____ Air Force: _____

Coast Guard: _____ National Guard: _____

War or Peace time period

Civil War: _____ Spanish American: _____ World War I: _____

World War II: _____ Korea: _____ Vietnam: _____ Persian Gulf: _____

Iraq:_____ Peace Time: _____

Signed by: ____________________________________________________

Date: __________ Cash: _____ Check number: _____

Received by: _________________________________________________

Organization & Post Number: ___________________________________