Veteran's Eligibility Pre-Certification Application

State Of Missouri Veteran's Cemetery Pre-Certification Application
First Name
Middle Name
Last Name
Suffix
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Daytime Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Social Security Number
VA Claim Number (if known)
If the veteran's spouse will be buried with the veteran, please provide the following information and attach a copy of the marriage certificate.
Spouse's Name
Spouse's Social Security Number
Spouse's Date Of Birth
Spouse's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preference of Missouri State Cemeteries

BloomfieldFort Leonard WoodHigginsvilleJacksonvilleSpringfieldOther
If Other, please indicate location
Attach DD214 (required)
Attach Marriage Certificate (if for spouse)
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State Of Missouri Veteran's Cemetery Pre-Certification Application