This text was obtained via automated optical character recognition.
It has not been edited and may therefore contain several errors.

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STATE HISTORICAL MARKER REQUEST FORM MISSISSIPPI DEPARTMENT OF ARCHIVES AND HISTORY
NAME OF HISTORICAL MARKER _____
SUGGESTED LOCATION OF MARKER
IS THIS REQUEST FOR A NEW OR A REPLACEMENT MARKER?___________
REFERENCES FOR DOCUMENTATION OF MARKER (Please include copies of any available research materials and at least one photo of the proposed marker location):
NAME OF INDIVIDUAL OR ORGANIZATION SPONSORING MARKER. PLEASE INCLUDE MAILING ADDRESS AND PHONE/ FAX NUMBER(S).
DOES THE SPONSOR WISH TO SUGGEST A MARKER TEXT?	____
IF SO, PLEASE INCLUDE A SAMPLE TEXT ON THE GRID PROVIDED.
The Department of Archives and History, in accordance with the policies adopted by the Board of Trustees, reserves the right to approve the final marker text.
SEND REQUEST FORM TO:
MISSISSIPPI DEPARTMENT OF ARCHIVES AND HISTORY
Attn: Jim Wood rick Post Office Box 571 Jackson, Mississippi 39205-0571 Telephone 601-359-6940 or Fax 601-359-6955