TO:
DEPARTMENT OF MARYLAND
VETERANS OF FOREIGN WARS OF THE UNITED STATES
Tiffany Daniel, State Chaplain
1105 Princeton Lane
Waldorf, MD 20602
Cell: 202-498-5678 Fax: 301-645-8404
E-Mail: mia_leads@
POST/DISTRICT CHAPLAIN REPORT
PLEASE PRINT OR TYPE ALL INFORMATION
District Number:___________ Post Number:________________ Date:____________________
Chaplain’s name:_______________________________________________________________
Address:______________________________________________________________________
City:_____________________________ State:_______________ Zip Code:_______________
Phone Number:________________________________________
DECEASED COMRADES
Name of Deceased:_________________________________ Date Deceased_______________
Address:______________________________________________________________________
City:_____________________________ State:_______________ Zip Code:_______________
Do you request the State Chaplain to send a sympathy card to the family of the deceased? Yes No
Name and Address of next of kin (for card only)_______________________________________ ______________________________________________________________________________
Did you participate in the funeral service? Yes No
Name of Deceased:_________________________________ Date Deceased_______________
Address:______________________________________________________________________
City:_____________________________ State:_______________ Zip Code:_______________
Do you request the State Chaplain to send a sympathy card to the family of the deceased? Yes No
Name and Address of next of kin (for card only)_______________________________________ ______________________________________________________________________________
Did you participate in the funeral service? Yes No
Name of Deceased:_________________________________ Date Deceased_______________
Address:______________________________________________________________________
City:_____________________________ State:_______________ Zip Code:_______________
Do you request the State Chaplain to send a sympathy card to the family of the deceased? Yes No
Name and Address of next of kin (for card only)_______________________________________ ______________________________________________________________________________
Did you participate in the funeral service? Yes No
SICK LIST
Name of Comrade:_________________________________ Card requested: Yes No
Address:___________________________________________ Card to Home Hospital
City:_____________________________ State:________________ Zip Code:______________
Date entered Hospital:__________________ Name of Hospital:__________________________
Address of Hospital:_____________________________________________________________
City:_____________________________ State:________________ Zip Code:______________
Did Post Chaplain or Officer visit Comrade during Hospitalization? Yes No
Name of Comrade:_________________________________ Card requested: Yes No
Address:___________________________________________ Card to Home Hospital
City:_____________________________ State:________________ Zip Code:______________
Date entered Hospital:__________________ Name of Hospital:__________________________
Address of Hospital:_____________________________________________________________
City:_____________________________ State:________________ Zip Code:______________
Did Post Chaplain or Officer visit Comrade during Hospitalization? Yes No
Name of Comrade:_________________________________ Card requested: Yes No
Address:___________________________________________ Card to Home Hospital
City:_____________________________ State:________________ Zip Code:______________
Date entered Hospital:__________________ Name of Hospital:__________________________
Address of Hospital:_____________________________________________________________
City:_____________________________ State:________________ Zip Code:______________
Did Post Chaplain or Officer visit Comrade during Hospitalization? Yes No
Name of Comrade:_________________________________ Card requested: Yes No
Address:___________________________________________ Card to Home Hospital
City:_____________________________ State:________________ Zip Code:______________
Date entered Hospital:__________________ Name of Hospital:__________________________
Address of Hospital:_____________________________________________________________
City:_____________________________ State:________________ Zip Code:______________
Did Post Chaplain or Officer visit Comrade during Hospitalization? Yes No
MONTLY TOTALS
Value of Flowers $__________________ Value of Fruit Baskets $____________________
Cards sent:______________ Hours:______________ Mileage:______________
NOTE: DO NOT REQUEST “GET WELL” CARDS TO BE SENT TO THE HOSPITAL, UNLESS THE COMRADE IS GOING TO BE THERE LONGTERM OR REHAB/NURSING CENTER. THANK YOU
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