Memorial Stone Order Form for Hospice Memorial Garden

Mail or deliver completed order form to:
In 2010 sixteen stones were placed in the
Hospice Memorial Garden, aiding in the
grieving process of many families. If you
would like to order a stone in memory of a
loved one or friend, you may complete the
enclosed form or contact Mary Ingersoll at
376-8211 or [email protected]
Friends of Lewis County HospiceMemorial Garden Fund
c/o Mary Ingersoll
5511 Jackson Street
Lowville, NY 13367
“To honor those we have loved and
lost who remain always in our
The Hospice Memorial Garden, located behind the Lowville Post Office in the Veterans’ Memorial Park, was established to help
those grieving the loss of a loved through
communing with Nature. Each year we see
the garden flourish with seasonal colors in
honor of our dear ones’ memories. The
beautiful setting with the angel statue attracts
many to use the garden site for wedding and
family photos. And so the deceased are never forgotten, but continue as a part of the
cycle of the living.
Memorial Stones Order Form
Hospice Memorial Garden
(Use a separate sheet for each stone ordered, please.)
Donor’s Name (print): ___________________
Address: ______________________________
Telephone :_______________ Date: _______
Pennsylvania Blue Stone Memorials
(2 sizes available—check one only)
_____ Small Stone (5 ½” tall X 11 ½” wide)
Donation: $100 each (Maximum of 3 lines with 17
characters and spaces per line.)
____Large Stone (11 ½” square)
Donation: $200 each (Maximum of 6 lines with 17
characters and spaces per line.)
Make checks payable to Friends of Lewis County
Hospice-Memorial Garden Fund.
Inscription on stone: (lettering and spacing will be
The Friends of Lewis County Hospice, Inc. is a
Not-For-Profit corporation established for the
following purposes: Initiating and conducting
fund raising activities for the benefit of Lewis
County Hospice; Promoting Hospice in the
Lewis County Community through pubic relations, volunteer recruitment and any and all activities as necessary for the support and maintenance of Lewis County Hospice; to advise the
Lewis County Board of Legislators on Hospice
related issues; and to solicit public and corporate
grants and contributions for the benefit of Lewis
County Hospice.
centered unless otherwise noted)
Limit: Small stone– 3 lines; Large stone– 6 lines
Do you need a receipt? ___Yes ___No
May we publish your name as a donor in a news release?
____Yes ____No
Authorization Signature: ____________________________
Memorial stones prepared by T. F. Wright, Carthage, NY.