Buy a Brick for the Lone Star School Plaza
If you would like to purchase a brick for the Lone Star School Plaza located on the
grounds of the Jersey County Historical Society, please print and complete this form and
mail it along with your check to:

                          Jersey County Historical Society
                          601 N. State Street                        
                          Jerseyville, Illinois 62052




Name:  __________________________________________________________________________________

Address:  ________________________________________________________________________________



I would like to purchase a 4" x 8" brick for $50. I would like it to read as follows:

____________________________________________________________

____________________________________________________________

____________________________________________________________


Each brick can contain one, two, or three lines of text. Each line of text may contain up
to 14 characters and may include a letter, number, or punctuation mark.