VA Form 40-1330 Claim for Standard Government Headstone or Marker

What Is VA Form 40-1330?

VA Form 40-1330, Claim For Standard Government Headstone or Marker is a form used to request a marble headstone or a bronze or granite marker for a deceased veteran. This form can be completed by the authorized person or a deceased's next of kin (NOK). The headstones and markers are furnished free of charge.

An up-to-date VA Form 40-1330 fillable version was released by the Department of Veterans Affairs (VA) in December 2017 with all previous editions obsolete. The form is available for digital filing and download through the link below.

Any deceased veteran discharged under honorable conditions and any service member of the U.S. Army who dies on active duty is eligible for a headstone.

VA Form 40-1330 form can be also used to request a new headstone or marker if the previous one was deteriorated, illegible, stolen or vandalized. If the inscription is incorrect, if the item damaged during shipping, or if the material or workmanship does not meet contract specifications, the new headstone or marker can be replaced at no charge.

This form is related to VA Form 40-1330M, Claim for Government Medallion for Placement in a Private Cemetery, which is used to request a medallion for a headstone. Veterans are entitled to either a traditional headstone, marker or a medallion.

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GENERAL INFORMATION SHEET
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 15 minutes 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
cannot conduct or sponsor a collection of information unless it has a valid OMB number. Your obligation to respond is voluntary, however, your response is required
to obtain benefits. 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 (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420. Please DO NOT send claims for benefits to this address.
PRIVACY ACT - VA considers the responses you submit confidential (38 U.S.C. 5701). VA may only disclose this information outside the VA if the disclosure is
authorized under the Privacy Act, including the routine uses identified in the VA system of records, 48VA40B, published in the Federal Register. VA considers the
requested information relevant and necessary to determine maximum benefits under the law.
BENEFIT PROVIDED
a. BURIAL HEADSTONE OR MARKER
Only for Veterans who died on or after November 1, 1990 - Furnished for the grave of any eligible deceased Veteran and provided for placement in
private and local government cemeteries regardless of whether or not the grave is marked with a privately-purchased headstone or marker.
Only for Veterans who died before November 1, 1990 - Furnished for the UNMARKED GRAVE of any eligible deceased Veteran. The applicant must
certify that a privately-purchased headstone or marker or Government-furnished headstone or marker is not present on the grave.
b. MEMORIAL HEADSTONE OR MARKER - Furnished to commemorate an eligible deceased Veteran whose remains have not been recovered or
identified, were buried at sea, donated to science, or cremated and the remains scattered. VA will only furnish a memorial headstone or marker after the
disposition of the Veteran's remains. A memorial headstone or marker must be placed in an established cemetery, and will not be used as a memento. For
a memorial headstone or marker please check box in block 34 and explain the disposition of the remains in block 33.
c. MEDALLION - Eligible deceased Veterans may receive a Government-furnished headstone or marker, or a medallion, but not both. If requesting a
medallion, please use VA Form 40-1330M, Claim for Government Medallion for Placement in a Private Cemetery.
d. PRESIDENTIAL MEMORIAL CERTIFICATE - A Presidential Memorial Certificate (PMC) is an engraved paper certificate, signed by the current
president, to honor the memory of Veterans discharged under other than dishonorable conditions. If the Veteran is eligible for a headstone, marker, or
medallion, one PMC will automatically be provided unless otherwise specified. Additional PMCs may be requested by indicating how many in block 22 of
this form.
WHO IS ELIGIBLE - Any deceased Veteran who was discharged under conditions other than dishonorable or any Servicemember of the Armed Forces of the United
States who dies on active duty may be eligible. Please attach a copy of the deceased Veteran's discharge certificate (DD Form 214 or equivalent) or a copy of other
official document(s) establishing qualifying military service. If you are unable to locate copies of military records, apply anyway, as VA will attempt to obtain records
necessary to make an eligibility determination. 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; please submit a copy of the Reserve Retirement Eligibility Benefits Letter with the claim. Reservists called to active duty other than training 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.
WHO CAN APPLY - Federal regulation defines “applicant” for a Burial Headstone or Marker that will mark the gravesite or burial site of an eligible deceased
individual as:
(i) A decedent's family member, which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the
decedent; a child, parent, or sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent;
(ii) A personal representative, defined as a family member or other individual who has identified himself or herself as the person responsible for making
decisions concerning the interment of the remains of or memorialization of a deceased individual;
(iii) A representative of a Congressionally-chartered Veterans Service Organization;
(iv) An individual employed by the relevant state, tribal organization, or local government whose official responsibilities include serving veterans
and families of veterans, such as a state or county veterans service officer;
(v) Any individual who is responsible, under the laws of the relevant state or locality, for the disposition of the unclaimed
remains of the decedent or for other matters relating to the interment or memorialization of the decedent; or
(vi) Any individual, if the dates of service of the veteran to be memorialized, or on whose service the eligibility of another individual for
memorialization is based, ended prior to April 6, 1917.
Federal regulation defines “applicant” for a Memorial Headstone or Marker to commemorate an eligible individual as a member of the decedent's family,
which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the decedent; a child, parent, or
sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent.
HOW TO SUBMIT A CLAIM
FAX VA Form 40-1330 claims and supporting documents to 1-800-455-7143.
MAIL claims to: Memorial Products Service (41B)
IMPORTANT: If faxing more than one claim - fax each
Department of Veterans Affairs
claim package (claim plus supporting documents) individually, i.e.,
5109 Russell Road
disconnect the call and redial for each submission.
Quantico, VA 22134-3903
SIGNATURES REQUIRED - The applicant signs in block 23; the person agreeing to accept delivery (consignee) in block 28, and the cemetery or other responsible
official in block 30. If there is no official on duty at the cemetery, the signature of the person responsible for the property listed in block 27 is required. Entries of
"None," "Not Applicable," or "NA" will not be accepted. State Veterans' Cemeteries are not required to complete blocks 25, 26, 27, 28 or 29.
ASSISTANCE NEEDED - 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. If additional assistance is needed to complete this claim, 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 claim. Use block 33 for any clarification or other information you wish to provide.
TRANSPORTATION AND DELIVERY OF MARKER - The headstone or marker is shipped without charge to the consignee designated in block 25 of the claim.
The truck driver is required to bring the pallet or monument to the end of the trailer. The consignee must utilize their equipment to unload the pallet or monument from
the truck. Deliveries will not be made to a Post Office box. You must provide the full delivery address and telephone number of the consignee. Please explain in
block 33 if the consignee is not a business. For delivery to a Rural Route address, you must include a daytime telephone number including area code in block 26. If
you fail to include the required address and telephone number, we will not deliver the marker. The Government is not responsible for costs to install or remove the
headstone or marker in private cemeteries.
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 claim. If inaccurate information is furnished, it may result in an incorrectly inscribed headstone or marker. Headstones and
markers furnished remain the property of the United States Government and may not be used for any purpose other than to be placed at an eligible individual's grave
or in a memorial section within a cemetery.
DETACH AND RETAIN THIS GENERAL INFORMATION SHEET FOR YOUR RECORDS.
VA FORM
40-1330
ALL PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE.
DEC 2017
GENERAL INFORMATION SHEET
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 15 minutes 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
cannot conduct or sponsor a collection of information unless it has a valid OMB number. Your obligation to respond is voluntary, however, your response is required
to obtain benefits. 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 (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420. Please DO NOT send claims for benefits to this address.
PRIVACY ACT - VA considers the responses you submit confidential (38 U.S.C. 5701). VA may only disclose this information outside the VA if the disclosure is
authorized under the Privacy Act, including the routine uses identified in the VA system of records, 48VA40B, published in the Federal Register. VA considers the
requested information relevant and necessary to determine maximum benefits under the law.
BENEFIT PROVIDED
a. BURIAL HEADSTONE OR MARKER
Only for Veterans who died on or after November 1, 1990 - Furnished for the grave of any eligible deceased Veteran and provided for placement in
private and local government cemeteries regardless of whether or not the grave is marked with a privately-purchased headstone or marker.
Only for Veterans who died before November 1, 1990 - Furnished for the UNMARKED GRAVE of any eligible deceased Veteran. The applicant must
certify that a privately-purchased headstone or marker or Government-furnished headstone or marker is not present on the grave.
b. MEMORIAL HEADSTONE OR MARKER - Furnished to commemorate an eligible deceased Veteran whose remains have not been recovered or
identified, were buried at sea, donated to science, or cremated and the remains scattered. VA will only furnish a memorial headstone or marker after the
disposition of the Veteran's remains. A memorial headstone or marker must be placed in an established cemetery, and will not be used as a memento. For
a memorial headstone or marker please check box in block 34 and explain the disposition of the remains in block 33.
c. MEDALLION - Eligible deceased Veterans may receive a Government-furnished headstone or marker, or a medallion, but not both. If requesting a
medallion, please use VA Form 40-1330M, Claim for Government Medallion for Placement in a Private Cemetery.
d. PRESIDENTIAL MEMORIAL CERTIFICATE - A Presidential Memorial Certificate (PMC) is an engraved paper certificate, signed by the current
president, to honor the memory of Veterans discharged under other than dishonorable conditions. If the Veteran is eligible for a headstone, marker, or
medallion, one PMC will automatically be provided unless otherwise specified. Additional PMCs may be requested by indicating how many in block 22 of
this form.
WHO IS ELIGIBLE - Any deceased Veteran who was discharged under conditions other than dishonorable or any Servicemember of the Armed Forces of the United
States who dies on active duty may be eligible. Please attach a copy of the deceased Veteran's discharge certificate (DD Form 214 or equivalent) or a copy of other
official document(s) establishing qualifying military service. If you are unable to locate copies of military records, apply anyway, as VA will attempt to obtain records
necessary to make an eligibility determination. 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; please submit a copy of the Reserve Retirement Eligibility Benefits Letter with the claim. Reservists called to active duty other than training 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.
WHO CAN APPLY - Federal regulation defines “applicant” for a Burial Headstone or Marker that will mark the gravesite or burial site of an eligible deceased
individual as:
(i) A decedent's family member, which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the
decedent; a child, parent, or sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent;
(ii) A personal representative, defined as a family member or other individual who has identified himself or herself as the person responsible for making
decisions concerning the interment of the remains of or memorialization of a deceased individual;
(iii) A representative of a Congressionally-chartered Veterans Service Organization;
(iv) An individual employed by the relevant state, tribal organization, or local government whose official responsibilities include serving veterans
and families of veterans, such as a state or county veterans service officer;
(v) Any individual who is responsible, under the laws of the relevant state or locality, for the disposition of the unclaimed
remains of the decedent or for other matters relating to the interment or memorialization of the decedent; or
(vi) Any individual, if the dates of service of the veteran to be memorialized, or on whose service the eligibility of another individual for
memorialization is based, ended prior to April 6, 1917.
Federal regulation defines “applicant” for a Memorial Headstone or Marker to commemorate an eligible individual as a member of the decedent's family,
which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the decedent; a child, parent, or
sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent.
HOW TO SUBMIT A CLAIM
FAX VA Form 40-1330 claims and supporting documents to 1-800-455-7143.
MAIL claims to: Memorial Products Service (41B)
IMPORTANT: If faxing more than one claim - fax each
Department of Veterans Affairs
claim package (claim plus supporting documents) individually, i.e.,
5109 Russell Road
disconnect the call and redial for each submission.
Quantico, VA 22134-3903
SIGNATURES REQUIRED - The applicant signs in block 23; the person agreeing to accept delivery (consignee) in block 28, and the cemetery or other responsible
official in block 30. If there is no official on duty at the cemetery, the signature of the person responsible for the property listed in block 27 is required. Entries of
"None," "Not Applicable," or "NA" will not be accepted. State Veterans' Cemeteries are not required to complete blocks 25, 26, 27, 28 or 29.
ASSISTANCE NEEDED - 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. If additional assistance is needed to complete this claim, 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 claim. Use block 33 for any clarification or other information you wish to provide.
TRANSPORTATION AND DELIVERY OF MARKER - The headstone or marker is shipped without charge to the consignee designated in block 25 of the claim.
The truck driver is required to bring the pallet or monument to the end of the trailer. The consignee must utilize their equipment to unload the pallet or monument from
the truck. Deliveries will not be made to a Post Office box. You must provide the full delivery address and telephone number of the consignee. Please explain in
block 33 if the consignee is not a business. For delivery to a Rural Route address, you must include a daytime telephone number including area code in block 26. If
you fail to include the required address and telephone number, we will not deliver the marker. The Government is not responsible for costs to install or remove the
headstone or marker in private cemeteries.
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 claim. If inaccurate information is furnished, it may result in an incorrectly inscribed headstone or marker. Headstones and
markers furnished remain the property of the United States Government and may not be used for any purpose other than to be placed at an eligible individual's grave
or in a memorial section within a cemetery.
DETACH AND RETAIN THIS GENERAL INFORMATION SHEET FOR YOUR RECORDS.
VA FORM
40-1330
ALL PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE.
DEC 2017
ILLUSTRATIONS OF STANDARD GOVERNMENT HEADSTONES AND MARKERS
FLAT MARKERS
UPRIGHT HEADSTONE
BRONZE NICHE (Z)
BRONZE (B)
WHITE MARBLE (U) OR
LIGHT GRAY GRANITE (V)
This grave marker is 24 inches long, 12 inches wide, with 3/4 inch rise.
This niche marker is 8-1/2 inches long,
Weight is approximately 18 pounds. Anchor bolts, nuts and washers for
fastening to a base are furnished with the marker.
The base is not
5-1/2 inches wide, with 7/16 inch rise.
furnished by the Government.
Weight is approximately 3 pounds;
LIGHT GRAY GRANITE (G) OR WHITE MARBLE (F)
mounting bolts and washers are
furnished with the marker. Used for
columbarium or mausoleum interment.
Also
provided
to
supplement
a
privately-purchased
headstone
or
marker for eligible Veterans who died
This headstone is 42 inches long,
on or after November 1, 1990 and are
13 inches wide and 4 inches
buried in a private cemetery.
thick. Weight is approximately
230 pounds.
Variations may
occur in stone color, and the
This grave marker is 24 inches long, 12 inches wide, and 4 inches thick.
marble may contain light to
Weight is approximately 130 pounds. Variations may occur in stone
moderate veining.
color; the marble may contain light to moderate veining.
SMALL FLAT GRANITE (L)
This grave marker is 18 inches long, 12 inches wide, and 3 inches thick.
Weight is approximately 70 pounds. Variations may occur in stone color.
NOTE: Historic headstones (Prior to World War I) - 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. Another style headstone is
available for those who served with the Confederate States of America during the Civil War. Requests for these special styles should be made in block 33 of
the claim. It is necessary to submit detailed documentation that supports eligibility. Inscriptions on these headstone types are intentionally limited to assure
historic accuracy. For example, only rank above 'Private' was historically authorized; emblems of belief and the words 'Civil War' are not authorized.
INSCRIPTION INFORMATION
MANDATORY ITEMS - Information in English about the decedent (provided by an authorized applicant). Such items are: Legal Name, Branch of
Service, Year of Birth, Year of Death, and for State Veterans and National Cemeteries only, the section and grave number. 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), 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. The phrase "IN MEMORY OF" is a
mandatory inscription on all memorial headstones and markers, as required under 38 CFR 38.630(c).
OPTIONAL ITEMS - Information in English about the decedent (provided by an authorized applicant). Optional items are in bold outlines, which
includes month and day of birth in block 10A, month and day of death in block 10B, highest rank attained in block 12, awards in block 14, war service in
block 16, and emblem of belief in block 17. 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, e.g., Vietnam may be inscribed if the Veteran served during the Vietnam War period, even though the individual never
served in the country. Supporting documentation must be included with the claim if you wish to include the highest rank and/or awards.
-
ADDITIONAL ITEMS
Information in English or non-English text about the decedent (provided by an authorized applicant), consisting only of
characters of the Latin alphabet and/or numbers. Examples of additional items include appropriate 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 must be stated in
block 18, and are subject to VA approval. No graphics, emblems or pictures are permitted except authorized emblems of belief, the Medal of Honor, and the
Southern Cross of Honor for Civil War Confederates.
INCOMPLETE OR INACCURATE INFORMATION ON THE CLAIM MAY RESULT IN ITS RETURN TO THE CLAIMANT, A DELAY IN
RECEIPT OF THE HEADSTONE OR MARKER, OR AN INCORRECT INSCRIPTION.
Department of Veterans Affairs
National Cemetery Administration
Memorial Products Service
To: MEMORIAL PRODUCTS SERVICE (41B)
Fax Number: 1-800-455-7143
From:
Sender's Phone Number:
Fax Number:
Total No. of Pages (including cover sheet):
This optional fax cover sheet is provided for your convenience. This fax number is dedicated to the transmission of
applications for headstones, markers, and medallions. If you prefer, you may mail your application and supporting documents
to the address below:
Memorial Products Service (41B)
Department of Veterans Affairs
5109 Russell Road
Quantico, VA 22134-3903
The 1-800-455-7143 fax line only accepts applications for Government Headstones, Markers, Medallions and
Presidential Memorial Certificates. Applications for other Government Benefits will not be accepted.
Include all supporting documents with this application (i.e., DD Form 214 or equivalent discharge document).
IMPORTANT: If you are requesting a replacement headstone or marker due to an incorrect inscription, damage,
or non-receipt, please explain in Block 33 Remarks.
To submit multiple application packages: Fax one application package (application plus supporting
documents) at a time. You must disconnect the call and redial between each application package. Faxing several
applications without redialing between each one will delay the processing of your applications.
Form approved, OMB No. 2900-0222
Expiration Date: Dec. 31, 2020
Respondent Burden: 15 minutes
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
1. DID VA PREVIOUSLY DETERMINE
2. TYPE OF REQUEST
IMPORTANT: Please read the General Information Sheet before completing this form. Type or print
ELIGIBILITY FOR BURIAL AT A VA
clearly all information except for signatures. Illegible printing could result in an incorrect headstone or
INITIAL REQUEST (First time)
NATIONAL CEMETERY?
marker or delivery. Failure to complete each block may result in delayed processing. Blocks outlined in
REPLACEMENT (Specify
YES
NO
UNSURE
bold are optional inscription items. PLEASE INCLUDE MILITARY DISCHARGE DOCUMENTS.
reason in Block 33, Remarks)
4. GRAVE IS:
3. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (No Nicknames or titles permitted)
CURRENTLY MARKED
FIRST (Or Initial)
MIDDLE (Or Initial)
LAST
SUFFIX (Sr., Jr., II,
(with privately purchased marker)
III, etc.)
NOT MARKED
5. RACE OR ETHNICITY (You may select more than one. Information will be used for statistical purposes only.)
6. GENDER (Information will be used
7. AGE AT TIME
for statistical purposes only.)
OF DEATH
AMERICAN INDIAN OR ALASKA NATIVE
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
BLACK OR AFRICAN AMERICAN
WHITE
MALE
HISPANIC OR LATINO
OTHER (Specify)
FEMALE
VETERAN'S SERVICE AND IDENTIFYING INFORMATION (Use numbers only, e.g., 05-15-1941)
10A. DATE OF BIRTH
10B. DATE OF DEATH
8. VETERAN'S SOCIAL SECURITY NO. AND/OR SERVICE NO.
9. PLACE OF BIRTH (City and State or Country)
SSN:
AND/OR SVC. NO.:
MONTH
DAY
YEAR
MONTH
DAY
YEAR
PERIODS OF ACTIVE MILITARY DUTY (For additional space use Block 33)
12. HIGHEST RANK ATTAINED
11A. DATE(S) ENTERED
11B. DATE(S) SEPARATED
(No pay grades)
MONTH
DAY
YEAR
MONTH
DAY
YEAR
13. BRANCH OF SERVICE (Check applicable box(es) - must be consistent with rank in Box 12)
14. VALOR OR PURPLE HEART AWARD(S) (Documentation must be provided)
MARINE
COAST
AIR
ARMY AIR
MERCHANT
OTHER
MEDAL OF
DST SVC
SILVER
DST FLYING
PURPLE
AIR
OTHER
ARMY NAVY
CORPS
GUARD
FORCE
FORCES
MARINE
(Specify)
HONOR
CROSS
STAR
CROSS
HEART
MEDAL
(Specify)
16. WAR SERVICE (Check applicable box(es)
15. TYPE OF HEADSTONE OR MARKER REQUESTED (Check one)
17. EMBLEM OF BELIEF (Optional)
WORLD WAR II
PERSIAN GULF
EMBLEM NUMBER (Specify)
(See page 5 for available emblems)
KOREA
AFGHANISTAN
FLAT
FLAT
UPRIGHT
FLAT
BRONZE
UPRIGHT
SMALL FLAT
GRANITE
MARBLE
MARBLE
NICHE
GRANITE
GRANITE
BRONZE
VIETNAM
IRAQ
B
G
U
F
Z
V
L
OTHER (Specify)
NONE
18. ADDITIONAL INSCRIPTION/TERM OF ENDEARMENT (Optional) (Space will vary according to type of marker)
19a. NAME AND MAILING ADDRESS OF APPLICANT
19b. DAYTIME OR CELL PHONE NO. OF APPLICANT
(No., Street, City, State, and ZIP Code)
(Include Area Code)
19c. E-MAIL ADDRESS (Optional)
19d. FAX NO. (Optional)
20. ARE YOU:
CEMETERY MANAGEMENT
FAMILY MEMBER (Specify relationship)
VETERANS SERVICE OFFICER
(where the unclaimed remains are buried)
FUNERAL HOME MANAGEMENT
PERSONAL REPRESENTATIVE (Person responsible for decisions
OTHER (Specify)
concerning burial of decedent; include written authorization)
(that received the unclaimed remains)
21. I WOULD LIKE A PRESIDENTIAL MEMORIAL CERTIFICATE
22. IF "YES" HOW MANY?
YES
NO
CERTIFICATION: By signing below I certify the headstone or marker will be installed in the cemetery listed in block 27 at no expense to the Government and all
information entered on this form is true and correct to the best of my knowledge. I also certify, to the best of my knowledge, that the decedent has never committed a serious
crime, such as murder or other offense that could have resulted in imprisonment for life, has never been convicted of a serious crime, and has never been convicted of a sexual
offense for which he or she was sentenced to a minimum of life imprisonment.
PENALTY: The law provides severe penalties, which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact,
knowing it to be false or for the fraudulent acceptance of any benefit to which you are not entitled.
23. SIGNATURE OF APPLICANT
24. DATE (MM/DD/YYYY)
25. NAME AND DELIVERY ADDRESS OF BUSINESS (CONSIGNEE) THAT WILL
26. DAYTIME OR CELL
27. NAME AND ADDRESS OF CEMETERY OR FAMILY
ACCEPT PREPAID DELIVERY (No., Street, City, State, and ZIP Code; P.O. BOX
PHONE NO. OF
PLOT WHERE GRAVE IS LOCATED (No., Street, City,
IS NOT ACCEPTABLE) MUST SIGN IN BLOCK 28
CONSIGNEE
State, and ZIP Code) MUST SIGN IN BLOCK 30
(Include Area Code)
CERTIFICATION: By signing below I agree to accept prepaid delivery of the headstone or marker.
28. PRINTED NAME AND SIGNATURE OF PERSON REPRESENTING BUSINESS (CONSIGNEE) NAMED IN BLOCK 25
29. DATE (MM/DD/YYYY)
CERTIFICATION: By signing below I certify the type of headstone or marker checked in block 15 is permitted in the cemetery named in block 27.
30. PRINTED NAME AND SIGNATURE OF CEMETERY OR OTHER RESPONSIBLE
31. DAYTIME PHONE NO OF CEMETERY (Include Area Code)
32. DATE (MM/DD/YYYY)
OFFICIAL
33. REMARKS
34. CHECK BOX BELOW IF REMAINS ARE NOT BURIED AND
35. SECTION/GRAVE NO.
EXPLAIN BELOW (e.g., buried at sea, remains scattered, etc.)
(State Cemetery Only)
REMAINS NOT BURIED
VA FORM
40-1330
ALL PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE
DEC 2017
AVAILABLE EMBLEMS OF BELIEF FOR PLACEMENT ON GOVERNMENT
HEADSTONES AND MARKERS (See block 17)
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.
VA FORM 40-1330, DEC 2017

Download VA Form 40-1330 Claim for Standard Government Headstone or Marker

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VA Form 40-1330 Instructions

The form is made up of five pages with filling guidelines and general information provided on the first two and the last page. The instructions for completing the veterans headstone application are provided below.

How to Fill out VA Form 40-1330?

  1. Provide your personal information. This includes your full name, phone numbers, and the total number of pages.
  2. Indicate whether the VA has previously determined eligibility for burial at a VA national cemetery. The type of request is marked in Box 2. Enter the name of the deceased to be inscribed on headstone or marker in Box 3. If the veteran's grave is unmarked or if it is already marked with a privately purchased headstone or marker, indicate this information in Box 4.
  3. Enter the race and gender of the deceased in Boxes 5 and 6. Indicate their age at the time of death in Box 7. Enter the veteran's social security number and service number in Box 8. Provide their place of birth in Box 9. Enter their dates of birth and death in Box 10. Give periods of the veteran's active military service in Box 11 and their highest rank attained in Box 12. Specify their branch of service in Box 13.
  4. Box 14 is for indicating valor or purple heart award. Documentation proving receipt of the awards must be attached to the claim. Box 15 is for choosing the type of headstone or marker requested. The second page of the application instructions has illustrations of the types of headstones and markers available.
  5. Box 16 is for providing information about the war service. Box 17 is for choosing emblem of belief, if applicable. The last sheet of the form is a list of all available emblems. If there are any additional inscriptions or terms of endearment, they should be provided in Box 18.
  6. Identify yourself in Boxes 19 and 20. Indicate your name, mailing address, telephone number, email address, and fax number in Boxes 19a-d. Indicate your relationship with the deceased in Box 20.
  7. Mark Box 21 if a presidential memorial certificate is required, and the number of certificates in Box 22. The veteran's headstone application must be certified by the signature of the applicant and date in Boxes 23 and 24. By signing the form, you certify that all provided information about the deceased is true and correct.
  8. Enter the name and address of the organization or official who will accept the prepaid delivery of the headstone or marker in Box 25, usually, this is the cemetery or funeral home. Enter the phone number of the person accepting the delivery in Box 26. Enter the name and address of the cemetery where the headstone or marker will be placed in Box 27. Box 28 is for the signature of the person accepting delivery. Box 29 is for the date.
  9. Box 30 is for the signature of the cemetery official at the place of burial. Enter the phone number of the cemetery in Box 31, and the date in Box 32. Enter any additional remarks in Box 33.
  10. Box 34 must be completed if the remains have not been buried. Provide an explanation in Box 33, including the following specifics: cremated and ashes scattered, buried at sea, or donated to science. Box 35 is completed only if the decedent is to be buried in a State Veterans Cemetery. Enter the section and grave number should be entered in this box.

Where to Mail VA Form 40-1330?

The filled out VA 40-1330 Form can be submitted in two ways: via fax (1-800-455-7143) or by mail to the address of Memorial Programs Service (41B) within the Department of Veterans Affairs: 5109 Russell Road Quantico, VA 22134-3903.

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