STOLEN VALOR ACT OF 2007 NOTICE: This form can be completed ONLY by or for individuals who have been officially authorized this award, and this award appears on the individual's DD-214 or other Report of Separation. It is a federal offense to claim recipientship of an award that has not officially been authorized and the claimaint does not possess verifying documentation. If the recipient to be named has not officially been authorized this award DO NOT CONTINUE!

Recipient's Last Name:
First Name:
Middle Name:
Title: Jr Sr II III IV

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Name of NATION or COUNTRY where recipient served in combat zone:
( Example: Germany, Vietnam, Panama, Korea, Iraq, etc.)

What YEAR (19xx or 20xx) did the recipient arrive in the combat theater:

What YEAR (19xx or 20xx) did the recipient leave the combat theater:

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Recipient's Rank Title (Do Not Enter Paygrade!):

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Recipient's home or contact person's Address:

City, State:

ZipCode / Postal Code:

Phone:

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Name of Unit Recipient served in when earning the Combat Action Badge:

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Your FULL and complete email address.
(Do NOT use a live.com, hotmail.com or msn.com email address.):


Please re-type your email address for verification:

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Military serial numbers converted to social security numbers in July, 1969

• If recipient discharged BEFORE July, 1969 enter all of the digits in recipient's serial number -- NO LETTERS, NO SPACES, NO DASHES:
  

• If recipient disharged AFTER July, 1969 enter the last four digits only of recipient's social security number -- NO SPACES NO DASHES:
  

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This website established 21 December 2008