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Guidelines 1. Memorial and commemorative works shall recognize the service of individual Veterans of the United States Military. 2. Names of those who donate the memorial or commemorative works will not be included. 3. Applications for all Brick Pavers and Bench Pavers will be submitted for approval by the Veterans Committee. 4. Engraving on 4” x 12” Brick Pavers is limited to 3 lines, with 24 characters per line. 5. Engraving on Bench Pavers is limited to 4 lines, 36 characters per line (5 lines total after including Killed in Action) 6. Except for KIA, engraving may include only name, rank, branch and dates of service of the Veteran. 7. 4” x 12” Brick Pavers are $100 each. Payment must be remitted along with the application. 8. Bench Pavers shall form a border in front of each bench and are reserved to memorialize those Veterans who were killed in action while on active duty in the U.S. Military, based upon the following criteria: a. Only those killed in action, as substantiated by a Purple Heart; and b. The Veteran, or a parent, child or spouse of the Veteran, must have been a citizen of the City of Hoover at the time of death; and c. The death must have occurred on or after the incorporation of the City of Hoover (1967); and d. Engraving shall include name, rank, branch of service, date and place of death of the Veteran. “Killed in Action” is automatically included. e. There is no charge for Bench Pavers. However, in support of the memorial, donations may be made to the Hoover Park & Recreation Foundation. Instructions to Applicants 1. Complete the Application on the reverse side. 2. If applying for a Bench Paver, attach a copy of the Purple Heart citation to the Application. 3. Remit to the Hoover Park & Recreation Foundation your payment for each Brick Paver ordered. Only one Paver per application. All donations are tax deductible. 3. Mail or deliver the completed application, citation and accompanying payment (if applicable) to: City of Hoover Veterans Memorial c/o Hoover Park & Recreation Foundation 600 Municipal Drive Hoover, Alabama 35216 4. Alternatively, you may apply and pay by credit card on-line by visiting us at www.hooveral.org. ---PAGE BREAK--- Veterans Park Memorial ffoorr PPaavveerr Limit of One Application Per Paver Applicant Name: Address: James M. Patterson, Jr. Major, USAF 1963 - 1983 Sample Brick Paver: x 12”) First line: Name Second Line: Rank and Branch of Service Third Line: Dates of Service City: State: Zip: Phone: (Home) (Work) (Cell) VETERAN’S INFORMATION: Instructions: Beginning in the first block of each row, neatly fill in the text to appear on the Paver. Each letter digit, space and punctuation mark counts as one character, and each box may contain only one character. 4”x12” Brick Paver ($100 each) - Limited to 24 characters per line - Print Clearly (Veteran’s name. One character or space per block.) (Rank and branch of service. One character or space per block.) (Dates of Service. One character or space per block.) 24” x 24” Bench Paver (FREE – Reserved for Hoover KIA only.) - Limited to 36 characters per line. Killed in Action Hoover Resident: Address at time of Veteran’s death: Sample Bench Paver: (24” x 24”) Fourth Line: Date of Death Fifth Line: Province / Country James M. Patterson, Jr. Major, USAF Killed in Action 4-19-2005 Bagdad, Iraq Veteran’s Committee Review (For Internal Use Only) Service verified: Yes ( ) No ( ) Residency verified: Yes ( ) No ( ) N/A ( ) KIA status verified: Yes ( ) No ( ) Address verified: Yes ( ) No ( ) N/A ( ) Payment received: Yes ( ) No ( ) N/A ( ) Application approved: Yes ( ) No ( ) Signed: Date: