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: Atlantic Theater, Pacific Theater, American Theater, 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 Rating Title:

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Recipient's home or contact person's Address:

City, State:

ZipCode / Postal Code:

Phone:

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Name of Vessel recipient served on when earning the Combat Action Bar:

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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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Recipient's ID number:

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This website established 21 December 2008