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2. If you are purchasing a paving stone, please let us know how you’d like it engraved (fill out one form for each paver purchased). Each paver has room for up to three lines of text, with 20 characters per line (including letters, punctuation, and spaces). Make checks payable to Town of Pinetop-Lakeside include “Jack Barker Memorial Park” in the memo line.

   
   

   Mail payments to:

   Town of Pinetop-Lakeside

   Attn: Jack Barker Memorial Park

   325 W. White Mountain Blvd.

   Lakeside, AZ 85929

   
   

4. Name*
6. Phone
8. Email
10. Text Line 1*
12. Text Line 2
14. Text Line 3
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16. 1. Receive an email copy of this form.
17. Email address

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18. Submit

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