|
Click Here for
a printer-friendly version
MARINE
CORPS LEAGUE
FALLEN MARINE INFORMATION FORM
Name of fallen Marine __________________________
Date of death
____/____/____
Funeral Home________________________
Phone ____-____-______
Address of F.H __________________________________________________
Will there be visitation Yes ___No ___
Will
visitation be local Yes ___No ____
Date of visitation ____/____/_____ Time
_____________-- to _____________hrs
Location of visitation _____________________________________________________
Address of visitation (if other than F.H.) _______________________________________
Name of spouse _____________________Phone
_____-_____-________
Next of Kin(if other
than spouse)__________Phone
_____-_____-________
Mailing Address of Spouse(or
next of kin)
Name _________________________________________________
Address __________________________________________________
Apt.
_______
City ____________________________________
State ________Zip____________
Release of above information to the MCL
is approved:__________________________
(For M.C.L. use only)
Person receiving certificate _________________________________________________
Presented: Certificate __________Pendant
_________ Globe and Anchor _________
Presented by __________________________________________________________
Accompanied by _______________________________________________________
Time of presentation: Date _______/______/
_____ Time______ hrs.
Mailed:
Certificate
________Pendant _______Globe & Anchor
________Card__________
Comments : Use back of page if needed. *Memorial service
only
[CONTINUE TO PAGE 10]
|
