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Form 2 - Bucks County Veterans Benefits Form - Commissioners Of Bucks - Pennsylvania Page 2

Instructions

Discharge and certified copy of death certificate must accompany this application. No application will be given

Consideration unless fully completed. See below for more specific instructions.

A deceased Service Person is defined as any person, at the time of death, serving in, or having served in and been honorably

Separated from the Army, Navy, Air Force, Marine Corps, Coast Guard, or any women’s organization officially connected therewith,

(1)during any war or armed conflict in which the United States has been, is now or shall hereafter be engaged, or (2) in a zone

Where a campaign or state or condition of war or armed conflict (established by the records of the Department of Defense of the

Federal Government) then existed. (sec. 1908, ‘The County Code’ of 1955, as amended)

Application for the burial allowance must be filled WITHIN ONE YEAR OF DATE OF DEATH OF VETERAN. It should be made by

The next of kin, personal representative, friend or any veterans organization who or which assumes responsibility for the burial

Of the veteran. Certified copy of death certificate, service papers giving full information, as well as an itemized statement from

The undertaker of the expenses incurred in the burial must be attaché to this application.

Application for headstone, lettering on existing memorial, or concrete base for government marker or headstone shall be made

By any relative or friend of the deceased serviceman. THERE IS NO TIME LIMIT. Death certificate and discharge must accompany

The application. Approved by the County Commissioners must be obtained before commencement of work by the contractor.

Affidavit as to the erection of the memorial by the contractor is require as well as an invoice.

(To be detached and forwarded to the contractor)

ERECTION AUTHORIZATION

You are hereby authorized to erect a _______________________________on Grave #______________Lot #_______________

Range #________________, Section___________________in_______________________________________Cemetery located

In_______________________________, PA, as per your ___________________________amounting to $__________________

The Memorial is to be inscribed as follows: ____________________________________________________________________

(Name of Veteran)

(Year of Birth)

(Year of Death)

(Rank)

(Company)

(Regiment)

(Division)

(War)

Commissioners

________________________________________________

__________________________________________Commissioners

Form 2 - Bucks County Veterans Benefits Form - Commissioners Of Bucks - Pennsylvania Page 2