Funeral Honors Reqest Form

Funeral Honors Request

Fields marked with a are required.
Time & Date Information
Todays Date:
Date Picker
Todays Time:
Date of Ceremony:
Date Picker
Time of Ceremony:
Deceased Information
Last Name:
 First Name:
 Middle Name:
SSN:
 Service Branch:
 Grade:
Name of Person Receiving the Flag:
 Relationship:
How was Eligibility Verified:
       

[Please Note: A copy of Veterans' DD-214, NGB-22, or Discharge Certificate MUST be provided to receive military funeral honors.]
Event Information
Name of Location Where Honors Will Be Rendered:
Location Address 1:

Location Address 2:
 City:

State:
 Zip:
Service Type:
Services Requested:



Additional details, comments, requests, or concerns:
Point of Contact Information
Person Requesting Funeral:
Name of POC:


POC Email
 Phone:

[Please include area code.]
Funeral Home Name:

[Please send these forms to us as timely as possible. Our office and volunteers become strained when we are not given timely notification of funerals. We cannot stress this point enough.