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2. The City of Jackson is proud to honor our veterans by constructing the Jackson Veterans Memorial Park. A 12 inches by 12 inches granite plaque may be purchased in honor of or in memory of any person who has served or is serving honorably in any branch of the military of the United States of America. This includes those who serve(d) either in active duty or in the reserve. The veteran must have a connection with Butts County to be included in the park.

   
   

   To purchase a plaque, please complete the order form below, and fill in all blocks exactly as they should appear on the plaque. All letters on the plaque will be capitalized. Each plaque costs $175 and must be paid for in advance by cash or check made payable to Jackson Veterans Memorial Park. The payment and first 3 pages of the order form is to be submitted to City Hall or to the Jackson Veterans Memorial Park Committee. Payments can be mailed to:
   Jackson Veterans Memorial Park
   c/o City of Jackson
   P.O. Box 838
   Jackson, GA 30233

   
   

   When completing the order form, please use the following abbreviations as they apply to the veteran:

   • KIA - Killed in Action
   • POW – Prisoner of War
   • CIB - Combat Infantry Badge
   • MIA - Missing in Action
   • WIA - Wounded in Action
   
   

   Please remember that October 1st of each year will be the deadline for submitting orders for plaques. Any application submitted after October 1st will be held and the plaque will be inscribed and recognized at the following year's Veterans Day Celebration.

   If you have any questions concerning the park or the purchase of a plaque, please contact City Hall at 770-775-7535.

4. First Name, Middle Initial, and Last Name
5. Suffix
7. Rank and Branch of Service
9. Military Information
11. Dates of Service
    Range in years
13. Examples
    William James
    PO1 U.S. Navy WIA
    Purple Heart
    USS Nerersail
    1950-1970
    
    Sammy Smith
    Sergeant U.S. Army
    10th Mtn Division
    WWII CIB
    1940-1945
15. Special Requests
17. Purchaser Name
19. Phone Number
21. Address1
23. Address2
25. City
26. State
27. Zip Code
29. Payment

    Price - $175 per plaque

    1. Cash
    2. Check
30. Attachment
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field