Thank you for your interest in the Century Building Project!

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the below information. Be sure to include contact information, should we need to verify your request.

Each Century Building Plaque will cost $95.00. This covers not only the cost of the plaque but also a $30.00 tax-deductible donation to the Union Par District Council.

The finished plaque is approximately 8.5 x 5 inches with drilled holes for installation. You will be responsible for plaque installation.

Your family name and/or past owner names are optional; the address and year the property was built are required to be on each plaque.

Read the Century Building Project Expectations and Commitments here: https://docs.google.com/document/d/1IxjP9BZPdJo1Jt3pAJnyg1jAyPeo-p6Jou2Y7UNRT3M/edit?usp=sharing

All checks payable to Union Park District Council, 1821 University Ave W Suite 308, St. Paul, MN 55104

I acknowledge that I have read the Expectations and Commitments *

Yes

Is this a gift and/or would you like us to deliver it to a different address than the address on the plaque? If so, please provide the delivery address below.

Your name *

Address (Please write out "Street" "Avenue" "Boulevard" etc.) *

Names to be included on plaque (Include current and/or previous owners. There is a 32 character limit. All names must fit on one line of the plaque. This is optional)

Year Built *

Email *

Phone

Do you prefer to be contacted by phone or email? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Union Park District Council. Report Abuse

Forms