36C78618R0043-014.pdf

APPENDIX C – COMPLETION OF INSCRIPTION SERVICE(S)

I certify that the inscriptions have been completed per contract specifications on the government-furnished headstones, markers, or niche covers identified below.

Printed Name of VA Contractor: _______________________________________________

Signature:_________________________________________Date:___________

Check the appropriate box and enter the quantity of the type of headstone, marker or niche cover that has been completed and ready for inspection.

(A1) Blank Marble Memorial Wall Marker Quantity: ______

(C1) Blank Granite Memorial Wall Marker Quantity: ______

(H1) Blank Granite Niche Cover Quantity: ______

(I1) Blank Marble Niche Cover Quantity: ______

(J1) Blank Granite Marker, Thin Flat 3” Quantity: ______

(L1) Blank Granite Marker, Small Flat 3” Quantity: ______

(U1) Blank Marble Upright Headstone Quantity: ______

(W1) Blank Granite Upright Headstone Quantity: ______

Shipment Number (s) (required) rejects are to be marked:

I certify that the headstones, markers, or niche covers identified above were received by me and the quantity of items has been verified.

Printed Name of Cemetery:_________________________________________________

Signature:_________________________________________Date:___________