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Gold Star Lapel Pin
Replacement Recognition Application Form

INSTRUCTIONS:

1. Complete this form in full. ( Click here to email amerwar@amervets.com if you have any technical problems sending this Application Form after you have completed it )

2. Click the button at the bottom of this completed form to email it to The War Library, along with a photocopy of the required document(s) described on the Instruction Page, or you can Print and mail this form and the required documents to the Library's mailing address below.

Do Not Hilite, Underline, Circle, Colorize
Or Mark In Any Way The DD-214
Or Other Military Document Photocopy
You Will Be Sending.

Charge card or Debit card applicants: To expedite shipment of your Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

Veteran's LAST Name (as it appears on the Report of Separation):
FIRST Name (as it appears on the Report of Separation):

MIDDLE name (as it appears on the Report of Separation):
Title (Must appear on military documentation):Jr Sr II III IV

Is this veteran currently living, deceased or KIA:
  LIVING
  DECEASED
  KILLED IN ACTION

Rank Title (Please Do Not Abbreviate):

Paygrade
Enlisted
Warrant
Officer

Recipient's name:

Relationship to deceased:

Address:
City:
State:
ZipCode:
Phone (NO SPACES OR DASHES):

Your full and complete contact email address:

SERVICE NUMBER:
(Do Not enter any alphabet letters. Numbers only.)
★ Enter the veteran's 1st FOUR DIGITS ONLY  ☛ 
★ Enter the 2nd FOUR (or remaining) DIGITS ONLY   ☛ 

Date of Casualty:

Country of Casualty:

Other area:

If you are sending a Check please indicate:

  • I will mail a Check along with my application and documentation. The Library will receive my envelope within 10 days from today.

    • CHARGE or DEBIT CARD applicants:

    -- My current Card information is already on file from a previous Application

    If your Card information is not on file, please Complete the following...

    Payment Method

      Check Debit
      Visa
      MasterCard
      American Express
      Discover
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    After printing this form for mailing, please sign here:

    International shipping cost (U.S. veteran living outside the United States, please add the shipping cost you were quoted...

    TOTAL ADMIN PROCESSING/DELIVERY Choose one of the following...:

  • Lapel Pin Only $19.65 (shipping included)
  • Certificate Only [.pdf] (by email) $7.50
  • Certificate Only $27.43.50 (shipping included)
  • Certificate & Pin $36.11 (shipping included)
  • Certificate & Wallet Card $33.43 (shipping included)
  • Certificate & Pin & Wallet Card $42.11 (shipping included)
  • Certificate in Bond Enclosure $32.43 (shipping included)
  • Certificate in Bond Enclosure & Pin $41.11 (shipping included)
  • Certificate in Bond Enclosure & Wallet Card $38.43 (shipping included)
  • Certificate in Bond Enclosure & Pin & Wallet Card $47.11 (shipping included)

    LAMINATED PATCH FOR SHADOWBOX DISPLAY
    This laminated patch is designed for Shadowbox display or pouch uniform wear only. It is not designed for sew-on clothing wear

    -- No, I do not want the patch
    -- Yes, if a laminated patch is available, please include for display in my Shadow Box. $8.75

    Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?
    (Fee: $3.50) Available only when a published certificate is requested. Not available with emailed certificates.

  • No.
  • Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:


    • Official's name

    Official's Title

    Official's Agency Name (name of unit, vessel, office, school, etc.)

    Address

    City, State, Zip

    Would you like to receive the official, Gold Star Lapel Pin replacement medal and/or ribbon

  • Yes, please include the official medal and add an additional $10.50 to my total
  • No, I already have the hardwear

    • Would you like a published copy of My Military Medal Last Will And Testament?

  • No, I will obtain the free jpg copy

  • Yes, please include a Medal Will for a MALE heir of my Awards and add $4.00 to my total
  • Yes, please include a Medal Will for a FEMALE heir of my Awards and add $4.00 to my total

    • Would you like to track your package through the United States Post Office after it has been shipped (for twenty [.20] cents extra)?

  • Yes, add 20 cents to my total
  • No, I don't want to track my package

    • Ignore this final Question if you will EMAIL or have previously EMAILED a copy your DD-214...

    Would you like your mailed DD-214 scanned by The War Library and integrated into your 201A Award Report that will be emailed to you when your requested item(s) are sent to you? The scanning fee is $3.00 (a one-time fee)

  • Yes, add a one-time $3.00 to my total to Scan and Integrate my DD-214 into my Award Report
  • No, I will accept my Award Report without my DD-214 appearing in the Report

    • Click Here if the veteran's DD-214 is on file from a prior application
    Click Here if you have confirmed with The War Library that the veteran is listed in the Personnel Database
    New Applicants Click Here

    Your Application Form is now complete. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed or emailed. Non-personalized items such as hardwear may be exchanged or returned within ten days of delivery.

Records Chief (REC-AMW)
The American War Library
817 East Via Carmelitos
Virginia Building 319
Long Beach CA 90805-7549
Phone: 1-562-422-4100 (Pacific Time Zone)

LINK: Policy Statements On Display Recognitions and Hardwear
Name-personalized items that are produced uniquely for a recipient may not be exchanged or returned. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

Print a copy for yourself before clicking the bar below..