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Return with payment to: City of Louisville, Parks & Recreation Department, c/o Memorial Tree & <br />Bench Program, 749 Main Street, Louisville, CO 80027. <br />Name of Donor <br />Address <br />City State Zip <br />Home Phone Cell Phone <br />Email Address <br />❑ In Honor of Name <br />❑ In Memory of Name <br />Proposed Wording for Plaque /Inscription <br />Name of Card Recipient <br />Recipient Address <br />Recipient City State Zip <br />Please email for pricing information. Fees are subject to change. <br />Please make all checks payable to the City of Louisville. 50% payment is due upon approval with the <br />balance due upon installation. <br />For Office Use Only: <br />Approved <br />Approved with following conditions <br />Denied (Explanation) <br />16 <br />