State of Oregon: Oregon Military Department
OREGON MILITARY FUNERAL HONORS REQUEST FORM
Military Honors Department
Phone: 503-683-5265
Email: NG.OR.ORARNG.LIST.FUNERAL-HONORS@MAIL.MIL
|1 Date / Time Request Submitted: |2 Date / Time for Honors Ceremony: |
| | |
|3a Veteran Authorized Requests: |3bAdditional Honors Reserved for RETIREES ONLY: |
| | |
|Flag Presentation Taps |Firing Party Pallbearers |
|4 Type of Remains Present at Service: |Notes: |
| | |
|Casket Cremations No Remains Present (Memorial) | |
|5 Deceased Name: (Last, First, Middle) |6 Branch of |7 Status: (Check one) |8 Rate / Rank: |
| |Service: | | |
| | |Veteran Retiree | |
|9 SSN: |10 Date of Birth: |11 Date of Death: |12 How Was *Eligibility Verified? |
| |(mm/dd/yyyy) | | |
| | | |DD-214 NGB-22 Discharge Cert. |
|13 Name of next of kin: |14 Telephone Numbers: |
| |Day: Evening: |
| | |
* A copy of members DD-214, NGB-22 or discharge certificate MUST be provided to receive military funeral honors.
MORTUARY / FUNERAL HOME INFORMATION
|15Mortuary / Funeral Home Name: |16 POC: |
| |(Point of Contact) |
| | |
|17Address: |18Phone: |
| | |
|19City / State/ Zip: | |
| |20Mortuary is Providing Flag? Yes No |
LOCATION OF MILITARY HONORS
|21 Location Name: |22 POC: |
| | |
|23Address: |24 Phone: |
| | |
|26 City / State/ Zip: |27 How will TAPS be provided? |
| |Funeral Home Military Honors Member |
|28 Person to Receive Flag: |28a. Relationship to Deceased: |
| | |
Email this form AND verification of eligibility to Oregon Military Funeral Honors.
Email: NG.OR.ORARNG.LIST.FUNERAL-HONORS@MAIL.MIL
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