Name and Phone 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
No
Would you like us to send you a flag application?
*
Yes
No
Is the Next of Kin Interested in a Government Marker?
*
Yes
No
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 and Relationship of Next of Kin:
*
Next of Kin Address and Phone Number?
*
You can upload the DD214/Discharge Paperwork Here
Additional Comments: