Veterans Memorial Order Form (page 1 of 2) (print using "file print") The Germantown Area Veterans Memorial is a tribute to all Germantown area veterans who have served or are now serving their country. The only requirement to have the Veteran's name, period of service/ branch of service placed on the Granite Walls of Honor, is the Veteran's service to their Community must have been, been or is, honorable. There is no restriction on peace time or war time service, location, or branch of service. The Veteran can be serving at this time. The placement on the Granite Wall of the veteran's name/branch of service/period of service, can be ordered by the Veteran or the Veteran's family or a friend. The cost of each name placement is a tax deductable $100 donation. The Veterans Memorial is located in Firemans Park, Germantown, Washington County, Wisconsin near the corner of Park Avenue and Freistadt Road. ORDER REQUEST Name of Veteran ________________________________________________________________ Period of Service ____________________________________ (Civil War, WW I, WW II, Korean, Vietnam, ...) Branch of Service _________________________________ (Air Force, Army, Army Air Force, Coast Guard, Navy, Marines, WASP) Order placed by: (required) ______________________________________________________ Address: (please print) contact numbers ______________________________________________________ home: __________________________ ______________________________________________________ work: __________________________ ______________________________________________________ email: __________________________ I verify in signing and ordering this tribute that the veteran served or is serving honorably and the information provided is correct and can be shared with the greater Germantown Community. Signed: _____________________________________________________________________ Date: _______________________ Relationship: ____________________________________ Send a Check or Money Order in the amount of a $100 donation to the Germantown Area Veterans Memorial Inc. and send it with this completed order form, and a portrait picture. Germantown Area Veterans Memorial Inc. PO Box 485 Germantown, WI 53022-0485 For addition information, call Mel - 262/251-5919, Ken - 262/251-0256, or Jim - 262/377-2613 Sponsored by the Germantown Community, its Businesses, and the organizations American Legion Post #1 and Veterans of Foreign Wars Post #9202 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Veterans Memorial Order Form (page 2 of 2) Background Information: Full Name: _____________________________________________________________________ Full Names of Parents: ___________________________________________________________ (include mother's maiden name) Date of Birth: __________________________ If deceased, could you share their obituary? Date of Death: _____________________________ Burial Location: ________________________________________________________ *** Can you share a portrait picture, preferably in uniform, or a portrait picture of any sort? *** Details regarding when the person served: From When: __________________________________ To When: __________________________________ Units Served In: Where Did The Person Serve: Rank/Grade: ___________________________________________________________________ Military Occupation Speciality (what did the person do): Awards Received: Sign: _______________________________________________ Date: _____________________ (If you do not know this information, you might wish to send away for it. Go to the web site "www.archives.gov/veterans/evetrecs.index.htm/" and in the left column of the screen, "Request Military Service Records ...", then follow the instructions provided.)