Applicant:                                                                                           

Address:                                                                                           

Phone:                                           Cell:                                          

Deceased Person to be commemorated:                                             

Years of Residency in Stinson Beach: from                 TO:                    

Relationship to Stinson Beach:                                                          

                                                                                                           

                                                                                                           

                                                                                                           

                                                                                                           

Inscription copy: (SEE ATTACHED EXAMPLE)

Line #1: Name (max. 32 characters, including spaces):

 

­– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – ­

Line #2: Biographical Tag Line (max. 42 characters, including spaces):

 

 

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Line #3: Years relative to Stinson beach (max. 12 characters, including spaces):

 

­– – – – – – – – – – – –

Biographical information for THE Stinson Beach HISTORICAL SOCIETY:

(Additional information and photographs may be attached to this form)

Please send a check or money order for $XXX.00 with this application TO:

THE STINSON BEACH MEMORIAL

P.O. BOX 851

STINSON BEACH, CA 94970

Upon approval OF THIS APPLICATION, YOU WILL BE CONTACTED TO MAKE an appointment to select a COMMEMORATIVE STONE. (IF YOUR APPLICATION IS NOT APPROVED, YOU DEPOSIT WILL BE RETURNED.)

For Additional information, please call (415) 952-7556.

Commemorative Stone Application (download form).