Military Service Memorial
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 copy of the veteran's DD-214, WD AGO 53-55, NAVPERS 553, NGB 22, 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 the Recognition you may email this form today. The Recognition will be prepared and awaiting the arrival of the veteran's military document(s) and a printed copy of this application.

Service Branch:

Religion:
Other:
(Please note that the Denominational Image from the Chaplain Corps will be displayed only if available)

VETERAN'S Recipient'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):

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   ☛ 

VETERAN'S date of birth:

VETERAN'S date of death:

Please answer the only the following three questions that are applicable. Ignore the questions that do not apply:

  • 1. Was this veteran Killed in Action as a result of an act initiated by enemy oppostion or friendly fire? No Yes

  • 2. Was this veteran Honorably Discharged No Yes

  • 3. Was this veteran on active duty at the time of his/her death, but was not killed in action (described above) No Yes
    If "Yes", was this veteran pending courts martial or other legal proceedings No Yes

    YOUR Name:

    I have not moved. My current address info is on file from a previous application

    Street Address (YOUR's):

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

    YOUR full and complete email address:

    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:

      I want to purchase the Full Color...

    • PDF emailed (full color, printable) ($7.50) ( RECOMMENDED, No USPS shipping fee )
    • Document shipped ($27.43)...
         Document only with wallet card ($33.43)
    • Document shipped in Bond Enclosure ($32.43)...
         Document in Bond Enclosure with wallet card ($38.43)

      • (The shipping totals above include the USPS - Priority Mail shipping fee)

      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 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

      • 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..