Sorrowful Mother Shrine Memorial Order Form

Sorrowful Mother
S H R I N E

4106 State Route 269
(mail to: P.O. Box 319)
Bellevue, Ohio 44811-0319
Phone: (419) 483-3435
Fax: (419) 483-6400

Memorial

Information

Please use this information to plan your Memorial intentions prior to calling the office to discuss it with a staff member personally.

Name or Names for whom the Memorial will be ordered.

Person who is ordering the Memorial contact information.

The Intention - In Memory or In Thanksgiving.

The Specific Inscription to be placed on the plaque. The number of lines (1 - 5) differ based on the Plaque chosen and Location (see below).

MEMORIAL WALK LOCATION - choose one these

12" x 12" Granite Plaque up to 5 lines for $1,000

6" x 6" White Bronze Plaque up to 4 lines for $250

Memorial Walk Donor Board Insert up to 3 lines for $100

OUTDOOR CHAPEL, GROTTOES AND GARDEN LOCATION - choose one these

5 1/2" by 13" Red Bronze Plaque up to 4 lines for $1,000

3 3/4" by 9 1/4" Red Bronze Plaque up to 3 lines for $250

Memorial Board Insert up to 3 lines for $100

If Location desired is a Chapel, Grotto or Garden, please choose which Location is preferred.

If Location is Stations of the Cross, a 3-3/4 " x 9 " Red Bronze Plaque (Up to 3 Lines) for $250 is available. You may also choose a specific Station from 1 through 14 for

placement.

Thank You