Memorial Structure Application

Date & Time Received:                                                               By:                                                

 

COAT OF ARMS - WHITE CIRCLECity of Reading
Memorial Structure Application

This application must be submitted prior to the installation of any memorial placed in any
City-owned park.

 

Applicant Information
Please print

Organization Name:                                                                                                                                                                
Contact Name:                                                                                                                                                                                          
Daytime Telephone Number:                                                                Cell Number:                                                                    
Email:______________________________________________________________                                                                  
Address: (please include City, State, and Zip) ________________________________________________ 
Organization Telephone Number:                                                                                                                                    

 

____________________________________________________________________________________________________

 

Memorial Structure Information Please print

What type of monument would you like to install (statuary, structure, tree, plaque, artwork, marker, etc)?                                                                                                                                                                                              

 

What veterans group, civic group, or historical event will be honored                                                           

 

Where would you like to have the monument?                                                                                                  

 

Why did you choose this location?                                                                                                                            

 

__________________________________________________________________________________________________

 

What  are  the  candidate’s  outstanding  contribution(s)  to  the  community  in  terms  of  activities  or gifts?                                                                                                                                                                                            

 

__________________________________________________________________________________________________

 

How did the candidate enhance the community?                                                                                                

 

__________________________________________________________________________________________________

 

 

How will the candidate’s contributions be recognized in the future?                                                           

 

__________________________________________________________________________________________________

 

The candidate’s contributions have the greatest impact on whom?                                                               

 

How does the candidate relate to the facility or location of installation?                                                              

 

__________________________________________________________________________________________________

 

Are funds available to purchase, install and maintain the installation (statuary, structure, tree, plaque, artwork, marker, etc)?                                                                                                                                                                   

 

How will the installation be insured?                                                                                                                       

 

Requested date of installation                                                                                                                                                 

A photograph of the monument you wish to install and a detailed design plan and drawing must be submitted along with this application form. Design specifications should include materials, dimensions, tree species (if applicable) and placement.

I declare under penalty of perjury that to the best of my knowledge these statements are true and correct.

 

APPLICANT’S SIGNATURE:                                                                                                                                                     

Please print name:                                                                                                                                                                       
DATE:                                                                                                                                                                                                

 

o Historic Preservation Specialist Signature:                                                        Date:                             
o Planner Signature:                                                                                                         Date:                            
o Operations Division Manager Signature:                                                              Date:                              
o City Clerk Signature:                                                                                                       Date:                              
o County Veterans Affairs Director Signature:                                                         Date:                            

 

Please provide a copy of the signed application form and photograph/design plan/drawing of the monument with the formal recommendation to City Council.