Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
  1. 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.

  2. Range in years
  3. Examples
    William James
    PO1 U.S. Navy WIA
    Purple Heart
    USS Nerersail

    Sammy Smith
    Sergeant U.S. Army
    10th Mtn Division
  4. Payment
    Price - $175 per plaque
  5. Leave This Blank:

  6. This field is not part of the form submission.