MILITARY SERVICE MEMBER FORM
Please complete as much info as possible--send copy of DD214, picture, etc. if possible.
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Last Name *
First and Middle Names *
Rank
Military Branch
Date of Birth
MM
/
DD
/
YYYY
Place of Birth
Date of Death
MM
/
DD
/
YYYY
Place of Death
Location of Burial
Name of Cemetery
Date of Entry or Enlistment
MM
/
DD
/
YYYY
Date of Discharge
MM
/
DD
/
YYYY
War and/or Peace Time Service
Awards and/or Medals Received
KIA/WIA/MIA/POW Stats
Father
Mother
Spouse
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