HomeMy WebLinkAbout1-34-33Name j&
Unit
Block
Lot
Date of Mark -out
Date of Burial Time
Name of Funeral Home
Authorized . ��
RITA LOURDES BARRY
January 2, 1930—August 26, 2015
CITY OF 44
HOME OF PELICAN ISLAND
Certificate No. 2143
OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Rita Lourdes Barry 398 Warren Street, Sebastian, FI 32958
(name) (address)
In and for consideration of the sum of $700.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following Lot(s)/Niche(s)
Unit_i_Block_34_Lot(s)_33_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS
CITY OF SE
snnjr
anager
day of July, 2007.
RIDA
ATTEST:
Sall . Maio, MMC
City Clerk
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9944
NamXArisllhe A t (]Cash /� 7
Date 9-14-15 i�Check # 14-7
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501 362100 Taxable Rent -
001501 362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001218010 CobraServe
001501 354100
Code Enforcement Fines
001501 347557
Community Center Revenue
001501341920
Copies
001501 369900
Miscellaneous Revenue
001501 359000
Other Fines/Forfeitures
001501 351140
Parking Citation
001501 342100
Police Security Services
001501 343W5
o% 260.0 D
Total Paid 2,5 =�
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
SEAWINDS CREMATORY
Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www.seawindsfh.com
(772) 589-1933
We hereby certify that these are the remains of RITA LOURDES BARRY
v
,7 The remains were received
from SEAWINDS FUNERAL HOME & CREMATORY
Cremation Permit No. 15-73380-5195 Issued at INDIAN RIVER COUNTY
Date of Death AUGUST 26 , 2015
Date of Cremation - `1 l S By
Cremator
Ch risfi i 4 � Pf'ffs
/►►y2 OCL WCLy Crr-
P6urn Getz ch rcl e-nS , FL
33qto
CRYOF
HOME OF PELICAN ISLAND
i
1921 N. Central Avenue, Sebastian, FL 32958 • (772) 589-2545 • Fax (772) 228-9927
November 23, 2011
Christine Pitts
398 Warren Street
Sebastian, FL 32958
Dear Ms. Pitts:
Per our telephone conversation yesterday afternoon, this letter is to confirm that your father,
John J. Barry was inurned in the Sebastian Cemetery, Unit 1; Block 34; Lot 33 on May 13, 2010.
Our records show that a fee of $150.00 was paid on May 13, 2010, check no. #2075. This fee
was for the inurnment plus opening and closing of the lot.
Again we are sorry for your loss and wish you and your family well.
Sincerely,
Donna Cyr
Records Program Manager
Enclosure
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Name • R
Unit /
Block
Lot
Date of Mark -out
Date of Burial ,1--//,3/'O • Time ��•�IC VA 5
T
Name of Funeral Ho
Authorized by
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBAST_
NOME Qi PFU(AN ISLAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME:
ADDRESS: /
PHONE #:
(Che One)
_ `PEN BURIAL LOT Lot rte-.- Block _Unit
_OPEN CREMAINS LOT Lot 7_Block _Unit
__OPEN COLUMBARIUM NICHE Niche Block Unit
—W
BURIAL DATE AND SERVICE TIME: T' j,j /D
FOR DECEASED:
ivame
14AME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name
/.10
Signature Da e
I certify that I have determined the ownership of the above described site that all site fees and
administrative fees have been paid and authorize opening of same
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR.
w/ .
Name Signature Date
- ----------------------------------------------------------------------------------------------------------------------------
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid
Ogz / /V .
Cemet y S cton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
1225 Main Street, Sebastian, FL 32958
Telephone (77 2) 589-5330 -- Fax (772) 589-8570
July 25, 2007
Rita Lourdes Barry
398 Warren Street
Sebastian, A 32958
RE.- Interment Rights to Unit 1, Block 34, Lot 33 Sebastian Cemetery
Dear Ms. Barry:
Enclosed is City of Sebastian Certificate 2143 entitling you to full interment rights in
Unit 1, Block 34, Lot 33.
Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal
Cemetery.
If you have any questions, please contact our office.
sincerely,
Sally A. Mao, MMC
City Clerk
SAM:ar
enclosures
0 LY
.,, MF. OF
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
ped at time of purchase
Name(s) /
s-�
Address
772 - ski- la- 5'29
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt,?o- acknowledged in the sum of:
Dollars
on this day of , 2007 for the purchase of the following
described Cemetery Lot(s n r Niche(s).
Unit _/, Block , Lot(s) SZ -f Niche(s
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20) Opening & Closing
Vase and Ring for Niches (cost) Interment
Signature of Purchaser ity of Se
Disinterment
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery\RECEI PT.doc
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RITA LOURDES BARRY 4 4348
CHRISTINE B. PITTS t
398 WARREN ST. 63-4/630 FL
SEBASTIAN, FL 32958-4252 Date � L 1 488
Po to the
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li:063000047�: 0033886237311'4 48
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-
TERMS
'►"1 W �-li
Form approved, OMB No. 2900-0222
Re! nntlent Rurden: 15 minutes
IMPORTANT: Please read the General Information Sheet before completing this form. Type or
print clearly all information except for signatures. Illegible printing could result in an incorrect
1. TYPE Oheadstone or marker or delivery. Blocks outlined in bold are optional inscription items. Unless
7REQUEST
INITrst time) REQUEST indicated otherwise all other blocks must be completed. MILITARY DISCHARGE DOCUMENTS
SECEQUEST OR RELATED SERVICE INFORMATION IS REQUIRED.
�1 CORRECTED APPLICATION OR REPLACEMENT
2. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (NO NICKNAMES OR TITLES PE ED) 3. GRAVE IS:
FIRST (Or Initial) MIDDLE (Or initial) LAST SUFFIX n CURRENTLY MARKED
1-.--' (with privately purchased marker)
j 4) A K) � (SNOT MARKED
VETERAN'S SERVICE AND IDENTIFYING INFORMATION (Use numbers only, e.g., 05-15-1941)
4. VETERAN'S SOCIAL SECURITY NO. OR SERVICE NO. (Failure to complete
PERIODS OF ACTIVE MILITARY DUTY (For additional space use Block 27)
6A. DATE(S) ENTERED
6B. DATE(S) SEPARATED
will delay processing.)
MONTH
DAY
YEAR
MONTH
DAY
YEAR
SSN: OR SVC. NO.:
5A. DATE OF BIRTH SB. DATE OF DEATH
AY
YEAR MONTH
DAY
YEAR
ATTAINED (No pay grades) 8. BRANCH OF SERVICE (Check applicable box(es) - must be consistent with rank in Box 7)
ARMY MERCHANT OTHER
MARINE COAST
ARMY NAVY CORPS GUARD AIR FORCE AIR FORCES MARINE (Sp eci )
F n n 1-1 r n r-
PRR
RPLE HEART AWARD(S) (Documentation mast be provided) 10. WAR SERVICE (Check applicable box(es))
BRONZE PURPLE OTHER WORLD PERSIAN OTHER
SVC NAVY AIRFORCE SILVER STAR
OSS CROSS CROSS STAR MEDAL HEART (Speci) WAR II KOREA VIETNAM GULF (Speci J
- n n n n n n n
11. TYPE OF HEADSTONE OR MARKER REQUESTED (Check one)
12. DESIRED EMBLEM OF BELIEF
FLAT FLAT UPRIGHT FLAT BRONZE UPRIGHT
GRA GRANITE
EMBLEM NUMBER
NONE (Specify)(See reverse side of this form for authorized emblems)
BRONZE
B �- G U F CHE
!a Z V
L._J
ANDMAILING ADDRESSENo., Street, Sratel
( City,13B.
13A. NAMEMode)
DAYTIME PHONE NO. OF PERSON TO CONTACT
16. ARE YOU:
PERSON TO CONTACT FOR ADDITIONAL
OF P
FOR ADDITIONAL INFORMATION
58'i -
[7 NEXT OF KIN r."CEMETERY
INFORMATION f
k'IC
X 77 )
FUNERAL
1 DIRECTOR
14 E-MAIL ADDRESS (OptionLal)
�"
. [
�e''+f'1't;J'�
--.'
j G r
OTHER (Specify)
15. FAX NO. (Optional)
. �1ed.t'L L 3Z 5
C -77i) 22*-`iy 7
CERTIFICATION: By signing below I certify the headstone or marker will be installed in the cemetery listed in block 21 at no expense to the
Government and all information entered on this form is true and correct to the best of my knowledge.
17. SIGNATURE OF PERSON WHOSE VIAME APPEARS IN BLOCK 13A
18. DATE (MWDD/YYYY)
"1
19. AME D DELIVERY ADDRESS OF BU ESS (CONSIGNEE) THAT WILL
ACCEPT PREPAID DELIVERY (No., Street, City, State and ZIP Code); P.O. BOX
20. DAYTIME PHONE NO,
(Include Area Code)
21. NAME AND ADDRESS OF CEMETERY WHERE
GRAVE IS LOCATED (No., Street, City, State and
/S NOT ACCEPTABLE
ZIP Code)
CERTIFICATION: By signing below I agree to accept prepaid delivery of the headstone or marker.
22. PRINTED NAME AND SIGNATURE/OFPSON REPRESENTI G SINESS (CONSIGNEE) NAMED IN BLOCK 19(ALI4DDYYYY)
p, drlczio
CERTIFICATION: By signing b c i the type of hea tone or marker checked in block 11 is permitted in the cemetery named in block 21.
24. PRINTED NAME AND SIGNATURE OF CEWETERY OR OTHER RESPONSIBLE
FJFICIAL
25. DAYTIMEPHONENO. (Include Area Code)
l X72-) 5O9-
26. DATE (WDD/YYYY)
y/1/1%Z.
27. R MA S ( ptional inscription space will vary in Ize a ording to the type ofm ker)•
28. CHECK BOX BELOW IF REMAINS ARE
NOT BURIED AND EXPLAIN IN
BLOCK 27 (e.g., lostatsea, remains
scattered, etc.)
r! REMAINS NOT BURIED
STATE VETERANS' CEMETERY AND GRAVE LOCATION (Cemetery Use Only)
29. ID CODE
30. SECTION
31. GRAVE NO.
VAFO20RM M 40-1330 APPLICATION FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
AUTHORIZED EMBLEMS (See block 12)
The graphics shown below are of the 20 most requested emblems of belief for placement on government -furnished headstones/markers.
The listing below shows all emblems that may be requested.
0 I'M M
Li► ��
g 5
CHRISTIAN BUDDHIST JUDAISM PRESBYTERIAN CROSS RUSSIAN ORTHODOX CROSS
(Star of David)
t t
"T
(6) (7) ($) (9) (10)
LUTHERAN CROSS EPISCOPAL CROSS UNITARIAN CHURCH UNITED METHODIST CHURCH AARONIC ORDER CHURCH
(Flaming Chalice)
t + C
(11) (12) (13) (14)(17)
MORMON -ANGEL MORONI NATIVE AMERICAN CHURCH SERBIAN ORTHODOX GREEK CROSS MUSLIM
OF NORTH AMERICA CRESCENT AND STAR
(20) (21) (27) (29)(31)
COMMUNITY OF CHRIST SUFISM REORIENTED UNITED MORAVIAN CHURCH CHRISTIAN CHURCH UNITED CHURCH OF CHRIST
EMBLEMS OF BELIEF AVAILABLE:
CHRISTIAN CROSS (01)
BUDDHIST (Wheel of Righteousness) (02)
JUDAISM (Star of David) (03)
PRESBYTERIAN CROSS (04)
RUSSIAN ORTHODOX CROSS (05)
LUTHERAN CROSS (06)
EPISCOPAL CROSS (07)
UNITARIAN CHURCH (Flaming Chalice) (08)
UNITED METHODIST CHURCH (09)
AARONIC ORDER CHURCH (10)
MORMON (Angel Moroni) (11)
NATIVE AMERICAN CHURCH OF NORTH AMERICA (12)
SERBIAN ORTHODOX (13)
GREEK CROSS (14)
BAHAI (9 Pointed Star) (15)
ATHEIST (16)
MUSLIM (Crescent and Star) (17)
HINDU (18)
KONKO-KYO FAITH (19)
COMMUNITY OF CHRIST (20)
SUFISM REORIENTED (21)
TENRIKYO CHURCH (22)
SIECHO-NO-IE (23)
THE CHURCH OF WORLD MESSIANITY (lzunome) (24)
UNITED CHURCH OF RELIGIOUS SCIENCE (25)
CHRISTIAN REFORMED CHURCH (26)
UNITED MORAVIAN CHURCH (27)
ECKANKAR (28)
CHRISTIAN CHURCH (29)
CHRISTIAN & MISSIONARY ALLIANCE (30)
UNITED CHURCH OF CHRIST (3 1)
HUMANIST (American Humanist Association) (32)
PRESBYTERIAN CHURCH (USA) (33)
IZUMO TAISHAKYO MISSION OF HAWAII (34)
SOKA GAKKAI INTERNATIONAL - USA (35)
SIKH (KHANDA) (36)
WICCA (Pentacle) (37)
CHRISTIAN SCIENCE (Cross & Crown) (97)
MUSLIM (Islamic 5 Pointed Star) (98)
This application form is normally updated every two years. To obtain the most recent information about headstones and markers
including the complete and most current list of available emblems of belief (listing all names and graphics), please visit our website at
www.cem.va.gov. You may also request a copy of this list by contacting our Applicant Assistance unit toll free at 1-800-697-6947, or
via e-mail at: mps.headstonesp_va.gov. .
VA FORM 40-1330, AUG 2009
GENERAL INFORMATION SHEET
APPLICATION FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
FOR INSTALLATION IN A PRIVATE CEMETERY OR A STATE VETERANS' CEMETERY
RESPONDENT BURDEN- Public reporting burden for this collection of information is estimated to average one-fourth hour per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. VA may not conduct or sponsor, and the respondent is not required to respond to this information collection unless it displays a valid OMB
Control Number. Response is required to obtain benefit. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to the VA Clearance Officer (005R]B), 810 Vermont Avenue, NW, Washington, DC 20420.
Please DO NOT send applications for benefits to this address.
BENEFIT PROVIDED
a. HEADSTONE OR MARKER
For deaths occurring on or after November 1, 1990 - Furnished upon application for the grave of any eligible deceased veteran. Will be
provided regardless of whether or not the grave is already marked with a privately purchased headstone or marker. Applicant may be anyone
having knowledge of the deceased.
For deaths occurring before November 1. 1990 - Furnished upon application for the UNMARKED GRAVE of any eligible deceased veteran.
The individual must certify the grave is unmarked and a Government headstone or marker is preferred to a privately purchased headstone or
marker. A grave is considered marked if a monument displays the decedent's name and date of birth and/or death, even though the
veteran's military data is not shown. Applicant may be anyone having knowledge of the deceased.
b. MEMORIAL HEADSTONE OR MARKER - Furnished upon application for installation in a cemetery only to commemorate any eligible
veteran whose remains have not been recovered or identified, were buried at sea, donated to science, or cremated and the remains scattered; may
not be used as a memento. Check box in block 28 and explain in block 27. Applicant may be anyone having knowledge of the deceased.
WHO IS ELIGIBLE - Any deceased veteran discharged under conditions other than dishonorable. A copy of the deceased veteran's discharge certificate
(DD Form 214 or equivalent) or a copy of other official document(s) establishing military service must be attached. Do not send original documents; they
will not be returned. Service after September 7, 1980, must be for a minimum of 24 months continuous active duty or be completed under special
circumstances, e.g., death on active duty. Persons who have only limited active duty service for training while in the National Guard or Reserves are not
eligible unless there are special circumstances, e.g., death while on active duty, or as a result of training. Reservists and National Guard members who, at
time of death, were entitled to retired pay, or would have been entitled, but for being under the age of 60, are eligible; a copy of the Reserve Retirement
Eligibility Benefits Letter must accompany the application. Reservists called to active duty and National Guard members who are Federalized and who
serve for the period called are eligible. Service prior to World War I requires detailed documentation, e.g., muster rolls, extracts from State files, military or
State organization where served, pension or land warrant, etc.
HOW TO APPLY
FAX applications and supporting documents to 1-800-455-7143. MAIL applications to: Memorial Programs Service (41A1)
IMPORTANT: If faxing more than one application - fax each Department of Veterans Affairs
application package (application plus supporting documents) individually i.e., 5109 Russell Road
disconnect the call and redial for each submission. Quantico, VA 22134-3903
A Government headstone or marker may be furnished only upon receipt of a fully completed and signed application with required supporting
documentation.
SIGNATURES REQUIRED - The person responsible for the information on this form signs in block 17; the person agreeing to accept delivery
(consignee) in block 22, and the cemetery or other responsible official in block 24. If there is no official on duty at the cemetery, the signature of the person
responsible for the property listed in block 21 is required. Entries of "None," "Not Applicable," or "NA" cannot be accepted. State Veterans' Cemeteries are
not required to complete blocks 17, 18, 22 and 23.
ASSISTANCE NEEDED - If assistance is needed to complete this application, contact the nearest VA Regional Office, national cemetery, or a local
veterans' organization. No fee should be paid in connection with the preparation of this application. Use block 27 for any clarification or other information
you wish to provide. Should you have questions when filling out this form, you may contact our Applicant Assistance Unit toll free at: 1-800-697-6947, or
via e-mail at mps.headstones@,va.gov For more information regarding headstones and markers visit our website at www.cem.va.
INSTALLATION - The Government is not responsible for costs to install the headstone or marker in private cemeteries.
TRANSPORTATION AND DELIVERY OF MARKER - The headstone or marker is shipped without charge to the consignee designated in block 19 of
the application. The delivery will not be made to a Post Office box. The consignee should be a business with full delivery address and telephone number.
If the consignee is not a business explain fully in block 27. For delivery to a Rural Route address, you must include a daytime telephone number including
area code in block 20. If you fail to include the required address and telephone number information, we cannot deliver the marker.
CAUTION - To avoid delays in the production and delivery of the headstone or marker, please check carefully to be sure you have accurately furnished all
required information before faxing or mailing the application. Mistakes cannot be corrected after a headstone or marker has been ordered. Headstones or
markers furnished remain the property of the United States Government and may not be used for any purpose other than to honor the memory of the
decedent for whom the headstone or marker is issued.
DETACH AND RETAIN THIS GENERAL INFORMATION SHEET FOR YOUR RECORDS.
VA FORM ,10.1330 SUPERSEDES VA FORM 40-1330, MAY 2008, Adobe LiveCycle Designer
AUG 2009 `t WHICH WILL NOT BE USED.
ILLUSTRATIONS OF STANDARD GOVERNMENT HEADSTONES AND MARKERS
UPRIGHT HEADSTONE
WHITE MARBLE OR
LIGHT GRAY GRANITE
BRONZE NICHE
FLAT MARKERS
BRONZE
This niche marker is 8-1/2 inches long,
5-1/2 inches wide, with 7/16 inch rise.
Weight is approximately 3 pounds;
mounting bolts and washers are
furnished with the marker. For use if
entombment is in a columbarium or
mausoleum, or to supplement a private
monument, for deaths occurring on or
after November 1, 1990.
This headstone is 42 inches long, 13 inches wide
and 4 inches thick. Weight is approximately 230
pounds. Variations may occur in stone color, and
the marble may contain light to moderate veining.
This grave marker is 24 inches long, 12 inches wide, with 3/4 inch
rise. Weight is approximately 18 pounds. Anchor bolts, nuts and
washers for fastening to a base are furnished with the marker. The
base is not furnished by the Government.
LIGHT GRAY GRANITE OR WHITE MARBLE
This grave marker is 24 inches long, 12 inches wide, and 4 inches
thick. Weight is approximately 130 pounds. Variations may occur
in stone color; the marble may contain light to moderate veining.
NOTE: Civil War Era headstones - In addition to the headstone and markers pictured, two special styles of upright headstones are available for those who
served with Union Forces during the Civil War or for those who served in the Spanish-American War, and another for those who served with the
Confederate States of America during the Civil War. Requests for these special styles should be made in block 27 of the application. It is necessary to
submit detailed documentation that supports eligibility.
INSCRIPTION INFORMATION
MANDATORY ITEMS of inscription at Government expense are: Legal Name, Branch of Service, Year of Birth, and Year of Death. Branches of
Service are: U.S. Army (USA), U.S. Navy (USN), U.S. Air Force (USAF), U.S. Marine Corps (USMC), U.S. Coast Guard (USCG), and by exception, U.S.
Army Air Forces (USAAF), and other parent organizations authorized for certain periods of time and special units such as Women's Army Auxiliary Corps
(WAAC), Women's Air Force Service Pilots (WASP), U.S. Public Health. Service (USPHS), and National Oceanic & Atmospheric Administration (NOAA).
Different examples of inscription formats are illustrated above. More than one branch of service is permitted, subject to space availability.
OPTIONAL ITEMS are identified on the application in boxes with bold outlines. These items may be included at Government expense if desired.
Optional items include month and day of birth in block 5A, month and day of death in block 513, highest rank attained in block 7, awards in block 9, war
service in block 10, and emblem of belief in block 12. War service includes active duty service during a recognized period of war and the individual does
not have to serve in the actual place of war, i.e. Vietnam may be inscribed if the veteran served during the Vietnam War period, even though the individual
never served in Vietnam itself. Supporting documentation must be included with the application if you wish to include the highest rank and/or awards.
RESERVED SPACE for future inscriptions at private expense, such as spousal or dependent data, is allowed if requested in block 27 and if space is
available. Only two lines of space may be reserved on flat markers due to space limitations. Reserved space is unnecessary on upright marble or granite
headstones as the reverse side is available for future inscriptions.
MEMORIAL HEADSTONES AND MARKERS (remains are not buried). The words "In Memory Of' are mandatory and precede the authorized
inscription data. The words "In Memory Of' are not inscribed when remains are buried.
ADDITIONAL ITEMS may be inscribed at government expense if they are requested on the initial application and space is available. Examples of
acceptable items include terms of endearment, nicknames (in expressions such as "OUR BELOVED POPPY"), military or civilian credentials or
accomplishments such as DOCTOR, REVEREND, etc., and special unit designations such as WOMEN'S ARMY CORPS, ARMY AIR CORPS, ARMY
NURSE CORPS or SEABEES. All requests for additional inscription items should be stated in block 27, and are subject to VA approval. No graphics,
emblems or pictures are permitted except VA approved emblems of belief, the Medal of Honor, and the Southern Cross of Honor for Civil War Confederate
Veterans.
INCOMPLETE OR INACCURATE INFORMATION ON THE APPLICATION MAY RESULT IN ITS RETURN TO THE APPLICANT, A DELAY IN RECEIPT
OF THE HEADSTONE OR MARKER, OR AN INCORRECT INSCRIPTION.
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