Us Navy Funeral Honors Request Form Details

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QuestionAnswer
Form NameNavy Form
Form Length1 pages
Fillable?Yes
Fillable fields46
Avg. time to fill out9 min 31 sec
Other namesnavy funeral honors request form, america navy form, blank navy us narvy form, navy honors request

Form Preview Example

U.S. NAVY FUNERAL HONORS REQUEST FORM

2601B Paul Jones St., Bldg 1, Great Lakes, IL 60088

Funeral Honors Office: (847) 688-2414 OR (877) 478-3988

email to: MWFuneralHonors@navy.mil or fax request to: (847) 688-2454/2463

DD214 OR DISCHARGE CERTIFICATE MUST ACCOMPANY THIS REQUEST Please allow 48 hours advance notice.

DATE OF HONORS:

TIME OF HONORS: TIME ZONE:

URN

CASKET

OTHER (i.e. memorial service)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: LAST, FIRST, MIDDLE:

 

 

 

 

 

 

SERVICE:

STATUS: VETERAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAVY

 

 

MERCHANT

 

 

 

RETIRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MARINE

 

 

 

ACTIVE DUTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN:

 

 

 

RATE/RANK:

DATE OF BIRTH:

DATE OF DEATH:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II

WHERE WOULD YOU LIKE THE HONORS TO BE RENDERED?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CEMETERY

 

 

CHURCH

 

 

FUNERAL HOME

 

 

OTHER (Specify) ____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Honor Guard reports 45 minutes prior.

 

 

 

 

 

 

 

 

LOCATION NAME:

 

 

 

 

 

 

 

 

 

 

 

PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

COUNTY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY:

 

 

 

 

 

 

 

 

 

 

 

STATE:

 

 

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART III

 

 

 

 

NEXT OF KIN INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF PERSON TO RECEIVE FLAG:

 

 

 

 

 

 

 

 

 

RELATION TO DECEASED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY:

 

 

 

 

 

 

 

 

 

 

 

STATE:

 

 

 

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV

 

MORTUARY/ FUNERAL HOME INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF FUNERAL HOME:

 

 

 

 

 

 

 

POINT OF CONTACT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

PHONE:

 

 

FAX:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY:

 

 

 

 

 

COUNTY:

 

 

 

 

 

 

 

STATE:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*** FUNERAL HOME WILL

 

VALID EMAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROVIDE FLAG ***

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assigned Command must confirm with Navy Region Midwest and funeral home.

***FOR OFFICIAL USE ONLY - Privacy Sensitive - Any misuse or unauthorized disclosure may result in either civil or criminal penalties.***

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