Burial Allowance Application - Saginaw County Soldiers & Sailors Commission
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2SAGINAW COUNTY SOLDIERS & SAILORS COMMISSION
BURIAL ALLOWANCE APPLICATION
Name of Deceased: _________________________________________________________________
Address of Deceased: _______________________________________________________________
(LEGAL ADDRESS MUST BE IN SAGINAW COUNTY, MICHIGAN)
Date of Death: ____________________ Social Security Number of Decedent: ____________________
Name of Licensed Cemetery Where Buried: _____________________________________________
Name of Veteran (if not the deceased): _________________________________________________
Military Service Dates:
Entry: _____________________
Discharge: ______________________
Veteran must have at least 90 days of active duty military service during the time periods listed below to qualify for burial assistance.
WAR TIME SERVICE DAYS:
WWI: April 6, 1917 to November 11, 1918
Korea: June 27, 1950 to January 31, 1955
Extended for Service in Russia to April 1, 1920
Vietnam: February 28, 1961 to May 7, 1975
WWII: December 7, 1941 to December 31, 1946
Gulf Era: August 2, 1990 to a date to be determined
Name of Applicant: ______________________________________________________________________
Address of Applicant: ____________________________________________________________________
Relationship to Deceased: __________________ Applicant Telephone Number: _____________________
Name of Mortician: _______________________ Telephone: ________________________
Total Cost of Funeral: $__________________
Has the free V.A. Marker been applied for? Yes
No
(Please attach copy of the Funeral Bill)
ASSETS
There is a $40,000 asset limit when a husband or wife applies for their deceased spouse, for
all other applicants the asset limit is the cost of the funeral. For all applicants the following
items are excluded; the value of the home the deceased lived in and all life insurance.
Please answer all the following asset questions by putting either a 0(zero) or a dollar amount on the
line after the $(dollar sign). All property held jointly or individually must be counted.
Real Estate (except the deceased’s home)…
$______________
Cash on Hand (money in a checking or savings account)…
$______________
Stocks, bonds, certificates of deposit, or retirement accounts having cash value…
$______________
All vehicles in deceased name (wholesale value-minus the amount owed)…
$______________
TOTAL…
$______________
NOTARIZATION
STATE OF MICHIGAN
COUNTY OF SAGINAW
________
I, __________________________
_ BEING DULY SWORN, DEPOSES, AND SAYS THAT
HE/SHE COMPLETED THE FOREGOING APPLICATION FOR BURIAL ALLOWANCE AND THAT THE
FACTS THEREIN CONTAINED ARE TRUE AND CORRECT ACCORDING TO THE BEST OF HIS/HER
KNOWLEDGE.
Subscribed and sworn to before me this
__________Day of _______________
_______________________________
______________________________
Signature of Applicant
Notary Public, Saginaw County, Michigan
My Commission expires ______________
Your case may be one chosen for review at which time you will be contacted to confirm the asset information
listed on the burial application.
Revised 11/09 (all other forms obsolete)
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