Honorable Service Certificate Form – Fill Out and Use This PDF

To: The Department of Defense, Veterans and Emergency Management

Maine Veterans’ Services

117 State House Station

Augusta, Maine 04333-0117

REQUEST FOR HONORABLE SERVICE CERTIFICATE

VETERAN INFORMATION

LAST NAME: _________________________________FIRST NAME: ________________________MI:_____

SSN: ___________________________SVC#:________________________DOB:___________________

DISCHARGE DATE: ________________RANK:_____________
	BRANCH OF SERVICE
 ARMY	 MARINE CORPS  NAVY	 AIR FORCE	 COAST GUARD

OTHER: ___________________

DATES OF SERVICE: ____________ TO ______________ ; ______________ TO ______________

War Time Service (Check all that apply)

 World War II	 Korean War	 Vietnam War	Desert Shield/Storm
Other (Specify) ____________________________

Applying For:

Honorable Service Certificates (Check all that apply)

 World War II

 Korean War

 Vietnam War

(DD-214/military discharge showing service war time service and Honorable discharge must accompany request)

 Request presentation ceremony

 Mail certificate to address

REQUESTORS NAME: ___________________________________________________________________

RELATIONSHIP TO VETERAN: __________________________________________________________

HOME ADDRESS: _______________________________________________________________________

CITY/STATE/ZIP: _______________________________________________________________________

PHONE#:_________________________EMAIL:______________________________

_______________________________________

(YOUR SIGNATURE /DATE REQUIRED HERE)X

Veteran’s signature gives MVS permission to contact DVA if necessary to verify service and awards

***DO NOT FILL OUT BELOW THIS LINE-OFFICE USE ONLY***

REQUEST FILLED ON: DATE: _________________BY: ____________________________________

REQUEST FOR HONORABLE SERVICE CERTIFICATE

1.Certificates:

a.Certificates are issued for honorable service during a specific period: World War II, Korean War, Vietnam War, etc.

b.Certificates have, as a minimum: the Veteran’s name: wartime service displayed such as World War II, Korean War or Vietnam War; and a standard recognition of honorable service.

c.Certificates issued for World War II, Korean War, and Vietnam War have the likeness of the corresponding plaque imprinted on the certificate.

2.Eligibility: Members of the Armed Forces of the United States who served in time of war and meet the following criteria may receive award of the Maine Honorable Service Certificate. Only one certificate will be issued per qualifying period per veteran.

3.Criteria:

•Resident of Maine upon entry on active duty or current resident of Maine for the last five years.

•Honorable Discharge (General Discharge under Honorable Conditions does not qualify)

•Served during a recognized war period (dates listed below)

•Only living veterans will receive certificate

World War II Certificate	December 7,	1941 to December 31, 1946
Korean War Certificate	June 27, 1950 to January 31, 1955
Vietnam War Certificate	August 5, 1964 to May 7, 1975
	February 28,	1961 to August 4, 1964 (In-Country)
Persian Gulf Certificate	TO BE ESTABLISHED FY 2008

Honorable Service Certificate (Veterans who do not qualify for wartime certificate)

4.Application: Qualifying individual’s s applying for the certificate must forward a request in writing (see attached form) along with a copy of their military discharge attesting to the fact that an Honorable Discharge was granted and the veteran was a resident of Maine at the time of entry on active duty. Proof of service in a combat theater, POW, or MIA status is also required for wartime certificates.

5.Presentation of Certificate: The certificate can be presented to the veteran or next of kin by a representative of the State in a graduation style ceremony with other recipients. If the veteran requests a presentation ceremony, he/she will receive a letter notifying them of the date and time of the next ceremony in their region.