Njdmava Form 24P – Fill Out and Use This PDF

BRIGADIER GENERAL WILLIAM C. DOYLE VETERANS MEMORIAL CEMETERY

PRE-REGISTRATION

FORM

(ALL INFORMATION COVERED BY PRIVACY ACT)

PRE REG. NO.:

The rules and regulations of this State Veterans Cemetery state that the Veteran must be honorably discharged and have established legal residence prior to death or have been a legal resident of NJ for at least 50 percent of his/her lifetime.

				VETERANS	INFORMATION			Phone Number
VETERAN'S NAME :			LAST, FIRST, MI			DATE OF BIRTH:		ADDRESS
VET AKA/MAIDEN NAME:				CITY:		ZIP CODE:
				COUNTY :
									CLAIM NUMBER:
MARITAL STATUS				MEDALS		DISCHARGE AVAILABLE
MARRIED	WIDOWED		SINGLE	PH	BS	YES	NO	SERVICE NO:
DIVORCED	SEPARATED			SS		ORIG. OR	COPY	SS NO:
MILITARY STATUS		PERIOD OF SERVICE (cemetery office use only)				ACTIVE DUTY DATES				RESERVE DATES
ACTIVE DUTY			WWI	PEACETIME		ENTERED		RELEASED		ENTERED	RELEASED
RETIRED			WWII
VETERAN			KOREA			HIGHEST RANK			BRANCH
RESERVE			VIETNAM
				NEXT OF KIN INFORMATION
PHONE NUMBER							RELATIONSHIP
NAME AND COMPLETE ADDRESS							WIFE	HUSBAND	SON	DAUGHTER
							MOTHER	FATHER	SISTER	BROTHER
							OTHER:
							DEPENDENTS	YES	NO	AGE
DOB OF SPOUSE			VET ALSO	SS# OF SPOUSE			(provide supporting documentation)
			YES OR NO
				RELIGIOUS DATA				BURIAL PREFERENCE

BGWCDVMC-BURIAL REGULATIONS

WHEN THE SPOUSE AND/OR DEPENDENT OF A VETERAN PREDECEASES THE VETERAN, INTERMENT AT THE BRIGADIER GENERAL WILLIAM C. DOYLE VETERANS MEMORIAL CEMETERY IS PERMITTED WITH THE STIPULATION THAT UPON THE DEATH OF THE VETERAN HE/SHE AGREES TO BE INTERRED WITH THE SPOUSE AND/OR DEPENDENT.

FAILURE TO COMPLY WITH THIS REGULATION WILL RESULT IN THE DISINTERMENT OF THE VETERAN'S SPOUSE AND/OR DEPENDENT AT

THE COST OF THE NEXT OF KIN.

I HAVE READ AND UNDERSTAND THIS REGULATION AND WILL COMPLY.

X__________________________________________________________________

NJDMAVA FORM 24P, MAR 2009

TO PRE-REGISTER: Attach copy of DD 214/separation papers, Discharge Certificates must indicate

active duty service dates. Proof of NJ residency is required, examples include NJ Driver's License, NJ Voter's Registration Card a paid NJ real estate tax bill, a deed to NJ property, utility bill with the veterans name and NJ address appearing thereon; or

other similar documents indicating NJ residency

COMPLETE THIS FORM AND MAIL BACK TO THE CEMETERY

B/G WILLIAM C DOYLE VETERANS' MEMORIAL CEMETERY

350 PROVINCELINE ROAD

WRIGHTSTOWN NJ 08562

SECTION VIII - VETERAN STATUS VERIFICATION

(FOR BGWCDVM OFFICE USE ONLY)

NEWARK REGIONAL OFFICE

CONTACTS NAME:

DATE: TIME:

NOTES:

BGWCDVMC- BURIAL REGULATIONS IX

WHEN THE SPOUSE AND/OR DEPENDENT OF A VETERAN PREDECEASES THE VETERAN, INTERMENT AT THE BRIGADIER GENERAL WILLIAM C. DOYLE VETERANS MEMORIAL CEMETERY IS PERMITTED WITH THE STIPULATION THAT UPON THE DEATH OF THE VETERAN HE/SHE AGREES TO BE INTERRED WITH THE SPOUSE AND/OR DEPENDENT.

FAILURE TO COMPLY WITH THIS REGULATION WILL RESULT IN THE DISINTERMENT OF THE VETERAN'S SPOUSE AND/OR DEPENDENT AT THE COST OF THE NEXT OF KIN.

I HAVE READ AND UNDERSTAND THIS REGULATION AND WILL COMPLY