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City of Lackawanna
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Veterans' Monument

The Veterans Stadium Committee is a volunteer group dedicated to the renovation of Veterans Stadium and the construction of a monument to honor all veterans, from all branches of the service.

For $150 you can have the name inscribed of any veteran on the monument, however any donation will be accepted. Please print and mail this form to the address below.

 

 

Print Form Print this form

Date ____________________________________________
Name of Requestor ____________________________________________
Address ____________________________________________
City ________________ State ________ Zip __________
Phone ____________________________________________
  Cost per name: $150   - Additional Contribution:____________________
Please accept my donation to Veterans' Stadium in the amount of _____________.
Checks should be made payable to:   Veterans' Monument Committee
Name as you would like it to appear on the monument * (please print clearly)
Name ____________________________________________
Branch of Service ____________________________________________
Name ____________________________________________
Branch of Service ____________________________________________
* A copy of an honorable discharge and/or DD214 of the veteran whose name is to be inscribed must be submitted with this form. If you are unable to locate this information, the Veterans Administration may be able to assist you.
Return this form to:
Veterans Monument Committee
640 Ridge Road.
Lackawanna, NY 14218

For Questions or additional information call: (716) 823-8841