Home Page - vetFuneralPortal

Name of Individual Reporting Death of Veteran *

Phone Number of Individual Reporting Death of Veteran *

Name of Funeral Home Reporting*

AJ Holly & Sons Funeral Home (Waupaca)

Cline Hanson Funeral Home (New London)

Dahlke Funeral & Cremation Care (Manawa)

Dahlke Funeral & Cremation Care (Weyauwega)

Eberhardt-Stevenson Funeral Home & Crematory (Clintonville)

Eberhardt-Stevenson Funeral Home & Crematory (Marion)

Lewin Funeral Home (Fremont)

Maple Crest Funeral Home, Inc (Waupaca)

Voie Funeral Home (Iola)

Other

Would you like a copy of the DD214/Discharge Paperwork?*

Yes

Would you like us to send you a flag application?*

Yes

Is the Next of Kin Interested in a Government Marker?*

Yes

Veteran's Name (First MI Last)*

Veteran's Residence?*

Veteran's Date of Birth (mm/dd/yyyy)?*

Veteran's Social Security Number (xxx-xx-xxxx)*

Veteran's Place of Birth?*

Veteran's Date of Death (mm/dd/yyyy)?*

Veteran's Place of Death?*

Veteran's Date of Burial (mm/dd/yyyy)?

Veteran's Place of Burial (Name of Cemetery and City/Town Located - Include Plot Location (if possible)*

Name of Next of Kin:*

Relationship of Next of Kin:*

Next of Kin Address?*

Next of Kin Phone Number?*

You can upload the DD214/Discharge Paperwork Here

Additional Comments: