Application-For-Name-To-Be-Placed-On-The-Memorial

Application For Name To Be Placed On The Memorial In The Tony And Marie Berris Memorial Park

Date

The Berris Memorial Park was designed to honor those individuals who have met one of the following criteria:

To an individual withThe proposed individual has The proposed individual disabilities that such a spearheaded a site that the youth has contributed many years of service to the youth ofperson could have easilyof Honesdale could use to excused themselves from develop their skills and minds and Honesdale Borough with little or no compensationsuch devotion to the youth,use the site for recreation during received for those services.but yet continued theirtheir growing years. (example: service.pool, sports field)

Name of Individual To Be Honored

Provide a brief description of the above named individuals service to the youth of Honesdale Borough

Your Printed Name

Telephone Number

Signature

Honesdale Boro Recreation Commission

Reason