Veteran Id Application Form printable pdf download

O F F I C E O F T H E W A R R E N C O U N T Y C L E R K

P A M E L A

J .

V O G E L ,

C O U N T Y

C L E R K

J O D Y

R O S S ,

D E P U T Y

“Return the Favor…Thank You For Your Service”

Veterans Program

Warren County, New York

Veterans Identification Card Application

Name: _______________________________________________________________________

Last Name

First Name

Middle Initial

Current Address:

____________________________________________________________

City:_________________________________

State: NY Zip Code: ___________________

Mailing Address (if different): ___________________________________________________

City: ________________________________ State: NY

Zip Code: ___________________

Telephone/Cell #: _____________________ Date of Birth: ___________________________

Social Security # (last 4 digits only):XXX-XX-____________

Branch of Service:

_______________________________

Source of Discharge/Honorable Service: DD 214 : Yes____

No_____

Military Discharge Book ______

Page _____

County of Recording: ________________

Note:

If recorded in another county and you are now a resident of Warren County, please provide the correct County and

recording information. If you are unable to locate your documentation, please contact Veterans’ Services @ (518)

761-6342 for assistance. Also: Recorded Discharge is a sealed record & is not open to the public (NYS Laws:

Ch 298 of 2005).

Other Source: _______________________________________________________________

I certify that I have been honorably discharged from service.

Signature: _____________________________________________

Date: ____________

Bring Application to Warren County Clerk’s Office, 1340 State Route 9, Lake George, NY 12845

– for photo and card issuance. Must be Warren Co. Resident and/or Property Owner

Note: This information to be used solely by the Warren County Clerk and Veterans’ Service. It is not for

distribution, commercial or otherwise.

Issue Date: _________________________

Thank You For Your Service!!!

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Veteran Id Application Form

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