Commemorative Plaques Order Form
8" x 5" brass-finish plaque with black lettering in honor or memory of your loved one.
Will grace the risers of the steps of the
Joe McCarty Stairway
in the Sullivan County Historical Museum

Cost is $50 each, with all proceeds going to support the museums.

Sketch your desired design in this box:
Please return this form along with your check for $50 per plaque
plus a clear black-and-white or color photo if desired. Photo will be returned.


Donor's name__________________________________________________


City, ST ZIP__________________________________________________