Due to different marker design layouts, the actual placement
of names, DOB, DOD, and emblem may vary slightly from your layout.


Name:______________________________________________________DOB:____________________DOD:______________________

Name:______________________________________________________DOB:____________________DOD:______________________

                                     Include vase:   Yes_____   No_____                   Include scrolls:   Yes_____   No______

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J & T Foundry and Design
1992 Badger Rd.
North Pole  AK
99705

Toll Free: 1-877-488-9177
Phone: (907) 488-9177
Fax: (907) 488-8638
Email: sales@jandtfoundry.com
  service@jandtfoundry.com