Typeset from the PDF of the official document — extraction method is not certified for this historical record; headings, motions and recorded votes are detected automatically, so spacing may differ from the original. The official copy governs.
Office Use Only Order # Received: Ck# Amount: Brick Order Form The Town of Clay Memorial Park
(315) 652-3800 ext. 179 The Town of Clay is proud to support a Memorial Park at its main office. This area is for anyone interested in taking a walk through a serene atmosphere while reflecting on loved ones who have passed, as well as honoring the victims who tragically lost their lives on September 11, 2001 (911). We invite you to take a "Walk of Memories" in a calming environment.
Interested in purchasing an engraved brick? Engraved bricks may be purchased for *$50.00 each by completing the information at the bottom and on the reverse side of this form. Your loved one can become a permanent part of the Town of Clay Memorial Park.
*amount based on vendor and market fluctuations Example Example 2 Example 3 John Doe Jane Doe Jane Doe Teacher Murphy
Purchased by: Phone:
Address:
Brick Purchase: $ . Please enclose a check or money order made payable to the Town of Clay (We do not accept cash as a method of payment). All engraved brick requests are at the approval of the Clay Town Board. Bricks are not engraved during winter months. You will be called when your brick is ready. Name to contact when Brick is ready:
Signature:
Brick Size – 8” x 4” x 2 ¼” ● Up to 3 lines per brick 13 spaces each including letters spaces and punctuation Brick 1 Fill out exactly as you wish it to appear on your brick Brick 2 Fill out exactly as you wish it to appear on your brick Brick 3 Fill out exactly as you wish it to appear on your brick