Tell us about the plaque

Thanks for identifying a plaque that is not already on this website. Fill in as much as you can and anything you don't know can be left blank.
All of the data on Open Plaques is released into the public domain completely licence-free. By providing us with information you are agreeing that it will be public domain also.
Type in the words on the plaque, in sentence case, excluding the organisation. e.g. 'John Smith 1900-1980 lived here'.
just the town name please, no area or postal code

and when?