We would be honored if you would complete this form and submit it as soon as possible. Thank you for Your Service.
PLEASE COPY AND PASTE THE FOLLOWING ON A WORD DOCUMENT AND EMAIL OR SEND COMPLETED FORM TO:
- Ray Goodgame at raygood8@aol.com
- South Lake County Historical Society 490 West Avenue, Clermont, Florida 34711
- or you can drop off completed forms to the Historic Village, on Saturdays or Sundays from 1:00 pm to 4:00 pm
Name__________________________________________
DOB___________________ DOD____________________
Born in_________________________________________
Rank/Branch of Service __________________________
Theater Served__________________________________
The cost for the name plate is $25.00. If assistance is needed contact Ray Goodgame 352-243-9696.