APPLICATION FOR INTERMENT

Transcription

1 APPLICATION FOR INTERMENT ARIZONA VETERANS MEMORIAL CEMETERY SIERRA VISTA MARANA CAMP NAVAJO PH: PH: PH: FAX: FAX: FAX: DECEDENT NAME: Legal name First middle last suffix SSN# Date of death Date of birth Gender: M F Marital Status: Married Divorced Widowed Never Married Unknown Relationship (to Veteran) (Spouse and Dependants) A fee is required prior to service. Place of residence Last known: City, State, Zip code, County of decedent FUNERAL HOME: Contact Phone Leave blank if family member is making arrangements LEGAL NEXT OF KIN Relationship DOB:( spouse only) SS#(spouse only) Mailing Address City State Zip code Phone address: Is spouse a veteran If yes Does surviving spouse want a set aside grave? If yes, provide copy of discharge. VETERAN: First middle last suffix Service# SSN# VA Claim # Military Status: Veteran Retired Military Active Duty Branch of Service: Army Air Force Navy Marine Corps Coast Guard Other Active Duty Dates: Entry Discharge Highest Rank Entry Discharge Highest Rank Display war periods on marker? Yes No If yes, which war period(s) Committal Shelter Veterans Chapel (Sierra Vista Only) None Honors Branch of service (Scheduled by funeral home or family.) Desired emblem of belief (specify) Casket Columbarium Cremation In-ground Cremation (Marana & Camp Navajo only) Procession: Scheduled services w/ family Direct-to-witness Direct (No witness) Requested date and time for service: Are there any previous interments under this veteran s eligibility? Name Date of birth MONUMENTS MARKERS WILL BE ORDERED ON THE DAY OF INTERMENT. Marker Additional Inscriptions such as LOVING PARENTS IN LOVING MEMORY : (Two lines- Columbarium niche -13 character spaces per line including spaces. Upright headstones 15 character spaces per line including spaces. Flat marker 2 lines 27 character spaces per line) Flat Marker Inscription Columbarium Niche Inscription Upright headstone inscription PLEASE FORWARD ALL AVAILABLE MILITARY DOCUMENTS Military documentation (DD214 etc.) and marriage certificate and or death certificate is required to determine eligibility and for awards and highest rank held. Information on this form will also be used to order the monument. Please insure that spelling and dates are accurate. I have certified that the above information is correct. SIGNATURE (NOK): DATE: (Next of Kin or Legal representative) ******************FOR OFFICE USE ONLY************************ SCHEDULING: Day Date Time Section Row Site Verified Docs Verified by: Revised 4/1/2016

2 Arizona State Veteran Cemetery Check list Call in to tentative schedule a service date and time. Interment application completely filled out and signed. Attached legible copy military discharge paper work (Generally this will be the DD214 form, Honorable Separation from Active duty, Veteran Affairs certificate of service etc.) If married, attach copy of marriage license, certificate of marriage or death certificate (This document will automatically verify the spouses eligibility for burial in a veterans cemetery) If spouse is a military veteran, copy of their military discharge paper work. Send application of interment and supporting documents. Call to verify receipt of documents. (See Application of Interment for contact information.) Military honors scheduled and verified by funeral home. (In the case of the funeral home not being involved contact AVMC staff.) Burial interment US Flag has been giving to the family. If not, contact your local post office and they will provide a burial flag free of cost. Interment $ fee has been paid by check or money order made out to AVMC and in memo section write the name of the dependent decedent (Dependent interments only) Links: Funeral Directors Resources Funeral Directors and NOK are responsible for scheduling of any clergy, honor guards and bagpipers that will be part of the Committal Service. Cemetery personnel can assist NOK with contact information for service if requested.

3 MARKER INSCRIPTION WORKSHEET LAST NAME: FIRST NAME & INITIAL: (include suffix, ie. Jr., Sr., II, III) RANK: BRANCH: WAR TIME: BIRTH DATE: DEATH DATE: EMBLEM OF BELIEF: Optional Additional Inscription for Columbarium Wall: MAJOR AWARDS: (Purple Heart, Bronze Star, Silver Star ect.) Optional Additional Inscription for Upright Granite: In-ground Cremated Remains Marker No Optional Additional Inscription available when spouse s name added PLEASE NOTE IF DOCUMENTATION PROVIDED FOR MEDAL RECIPEINTS, ONE LINE OF OPTIONAL INSCRIPTION WOULD NEED TO BE REMOVED FOR ALL OF THE ABOVE MARKER TYPES. Signature of next of kin: Date:

4

5

6 U.S. Department of Veterans Affairs National Cemetery Administration AVAILABLE EMBLEMS OF BELIEF FOR PLACEMENT ON GOVERNMENT HEADSTONES AND MARKERS (1) LATIN (CHRISTIAN) (2) BUDDHIST (3) JUDAISM (Star of David) (4) PRESBYTERIAN (5) RUSSIAN ORTHODOX (6) LUTHERAN (7) EPISCOPAL (8) UNITARIAN (Flaming Chalice) (9) UNITED METHODIST (10) AARONIC ORDER (11) MORMON (Angel Moroni) (12) NATIVE AMERICAN OF NORTH AMERICA (13) SERBIAN ORTHODOX (14) GREEK (15) BAHAI (9-Pointed Star) (16) ATHEIST (17) MUSLIM (Crescent and Star) (18) HINDU (19) KONKO-KYO FAITH (20) COMMUNITY OF CHRIST (21) SUFISM REORIENTED (22) TENRIKYO (23) SEICHO-NO-IE (24) THE OF WORLD MESSIANITY (25) UNITED OF RELIGIOUS SCIENCE (26) CHRISTIAN REFORMED (27) UNITED MORAVIAN (28) ECKANKAR (29) CHRISTIAN (30) CHRISTIAN & MISSIONARY ALLIANCE (31) UNITED OF CHRIST (32) HUMANIST EMBLEM OF SPIRIT (33) PRESBYTERIAN (USA) (34) IZUMO TAISHAKYO MISSION OF HAWAII (35) SOKA GAKKAI INTERNATIONAL (USA) (36) SIKH (KHANDA) (37) WICCA (Pentacle) Page 1 of 2

7 AVAILABLE EMBLEMS OF BELIEF (CONTINUED) (38) LUTHERAN MISSOURI SYNOD (39) NEW APOSTOLIC (40) SEVENTH DAY ADVENTIST (41) CELTIC (42) ARMENIAN (43) FAROHAR (44) MESSIANIC JEWISH (45) KOHEN HANDS (46) CATHOLIC CELTIC (47) FIRST OF CHRIST, SCIENTIST (Cross & Crown) (48) MEDICINE WHEEL (49) INFINITY (51) LUTHER ROSE (52) LANDING EAGLE (53) FOUR DIRECTIONS (54) OF NAZARENE (55) HAMMER OF THOR (56) UNIFICATION (57) SANDHILL CRANE (58) OF GOD (59) POMEGRANATE (60) MESSIANIC (61) Shinto Emblem (98) MUSLIM (Islamic 5-Pointed Star) is not shown due to copyright. February 2015