PLEASE READ: Complete entire form (PRINT/TYPE LEGIBLY) and forward verification (i.e.: DD214) of the deceased veteran’s
military service information to the fax number. NOTE: It is important that you follow-up with a phone call to ensure receipt of your fax.
PHONE: (202) 497-9641
FAX: (301) 981- 7065
EMAIL: honor.guard1@afncr.af.mil
FUNERAL HOME:
POINT OF CONTACT:
jo
ADDRESS:
PHONE:
SUBMITTED DATE:
NAME OF DECEASED:
(Circle One)
CREMATION or CASKET
(If casket Aprox Weight: _______
DATE OF BIRTH:
Terrain Obstacles?)
DATE OF DEATH:
SOCIAL SECURITY #: __________________________ SERVICE#:
BRANCH OF SERVICE: ______________________
RETIREE
VETERAN
RANK:
ACTIVE
GUARD/RESERVE
DATE OF ENTRY: __________________ DATE OF SEPARATION:
-----------------------------------------------------------------------------------------------------------------------------------------NEXT OF KIN:
PHONE NUMBER:
ADDRESS:
-----------------------------------------------------------------------------------------------------------------------------------------CEMETERY:
(OR – Name of Place of Memorial Service)
(Address – If known)
County: ___________________
City:
DATE OF BURIAL:
Day of Week
Month
TIME YOU ARE REQUESTING HONORS AT GRAVESIDE:
THIS INFORMATION IS SUBJECT TO THE PRIVACY ACT OF 1974
Day
Year