Women Veterans' Silver Commemorative Coin Form

ADVERTISEMENT

To: The Department of Defense, Veterans and Emergency Management
Maine Veterans’ Services
117 State House Station
Augusta, Maine 04333-0117
Phone: (207) 430-6035
Fax: (207) 626-4471
WOMEN VETERANS’ SILVER COMMEMORATIVE COIN
VETERAN INFORMATION
LAST NAME: _________________________________FIRST NAME: ________________________MI:_____
LAST NAME(S) SERVED UNDER:____________________________________________________________
SVC#:________________________
DOB:___________________
DISCHARGE DATE: ___________ RANK:____________ TYPE OF DISCHARGE: _________________
(must be Honorable or equivalent to qualify)
BRANCH OF SERVICE:
ARMY
MARINE CORPS
NAVY
AIR FORCE
COAST GUARD
OTHER: ___________________
DATES OF SERVICE:
____________ TO ______________ ; ______________ TO ______________
War Time Service (Check all that apply)
World War II
Korean War
Vietnam War
Desert Shield/Storm
Other (Specify) ____________________________
EX-POW
If home of record other than Maine at time of entry, how many years have you been a resident of Maine?__________
Veterans Address
:
______________________________________________________
Town
: ____________________________
ZIP Code: ___________________
PHONE#:_________________________
EMAIL:______________________________
________________________________________________
VETERAN’S SIGNATURE /DATE REQUIRED HERE)
PLEASE ATTACHED A COPY OF DD-214(s) OR MILITARY DISCHARGE
AND MAIL TO MAINE VETERANS’ SERVICES
PLEASE CIRCLE APPROPRIATE LOCATION
____ I will pick up my silver commemorative coin at the nearest Maine Veterans Services
Office
(circle office closest to you) Augusta Bangor Caribou Lewiston Machias
Portland Springvale Togus Waterville

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2