"Request for Gold Star Honorable Service Medal" - Maine

Request for Gold Star Honorable Service Medal is a legal document that was released by the Maine Department of Defense, Veterans and Emergency Management - a government authority operating within Maine.

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To: The Department of Defense, Veterans and Emergency Management
Maine Veterans’ Services
117 State House Station
Augusta, Maine 04333-0117
REQUEST FOR GOLD STAR HONORABLE SERVICE MEDAL
VETERAN INFORMATION
LAST NAME: _________________________________FIRST NAME: ________________________MI:_____
SSN: ___________________________SVC#:________________________DOB:___________________
DATE OF DEATH: ________________
RANK:_____________
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) ____________________________
Applying For:
 Gold Star Honorable Service Medal
(DD-1300 Military Certificate of Death must accompany application)
 Yes or  No, please mail to me.
I would like to attend an award ceremony to receive the above
REQUESTORS NAME: ___________________________________________________________________
Relationship to veteran: ______________________________________
HOME ADDRESS: _______________________________________________________________________
CITY/STATE/ZIP: _______________________________________________________________________
PHONE#:_________________________
EMAIL:______________________________
_______________________________________
YOUR SIGNATURE /DATE REQUIRED HERE)
Signature gives MVS permission to contact DVA if necessary to confirm service and death of individual on active duty
***DO NOT FILL OUT BELOW THIS LINE-OFFICE USE ONLY***
Application # _____________
Date Received _______________ Presented/Mailed ____________________
ELIGIBILITY CRITERIA ON BACK OF FORM
To: The Department of Defense, Veterans and Emergency Management
Maine Veterans’ Services
117 State House Station
Augusta, Maine 04333-0117
REQUEST FOR GOLD STAR HONORABLE SERVICE MEDAL
VETERAN INFORMATION
LAST NAME: _________________________________FIRST NAME: ________________________MI:_____
SSN: ___________________________SVC#:________________________DOB:___________________
DATE OF DEATH: ________________
RANK:_____________
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) ____________________________
Applying For:
 Gold Star Honorable Service Medal
(DD-1300 Military Certificate of Death must accompany application)
 Yes or  No, please mail to me.
I would like to attend an award ceremony to receive the above
REQUESTORS NAME: ___________________________________________________________________
Relationship to veteran: ______________________________________
HOME ADDRESS: _______________________________________________________________________
CITY/STATE/ZIP: _______________________________________________________________________
PHONE#:_________________________
EMAIL:______________________________
_______________________________________
YOUR SIGNATURE /DATE REQUIRED HERE)
Signature gives MVS permission to contact DVA if necessary to confirm service and death of individual on active duty
***DO NOT FILL OUT BELOW THIS LINE-OFFICE USE ONLY***
Application # _____________
Date Received _______________ Presented/Mailed ____________________
ELIGIBILITY CRITERIA ON BACK OF FORM
State of Maine Gold Star Honorable Service Medal
a. Eligibility: Members of the Armed Forces of the United States who served in time of war and
meet the following criteria may receive award of the Maine Gold Star Honorable Service Medal.
Only one medal will be issued to the next-of-kin per qualifying individual.
b. Criteria:
- Resident of Maine upon entry on active duty tour and
- Killed-in-Action or died of non self-inflicted causes while deployed in support of combat
operations on or after December 7, 1941
c. Recipient of Medal:
(1) Primary next-of-kin in order of priority.
- Spouse as long as spouse has not remarried. Spouse and veteran must have been
legally married in accordance with current Maine laws.
- Eldest Child (biological or adopted)
- Mother if veteran was not married and has no legal children
- Father if Mother not living at time of award.
- Eldest sibling as long as veteran was not married, has no legal children
(biological or adopted), and both parents are deceased.
(2) Secondary next-of-kin in order of priority if there are no primary next-of-kin
- Grandchild (eldest)
- Niece/nephew (eldest)
- Grandparents (maternal/paternal)
- Aunt/uncle (eldest)
- First Cousin (eldest)
- Any other adult relative in descending order of blood relationship
d. Application: Families of qualifying individual’s s applying for the award must complete
application form and forward the request along with a copy of DD Form 1300, Casualty Report
attesting to the fact that an Honorable Discharge was granted and the veteran was a resident of
Maine at the time of entry on active duty. In addition, your request must include a copy of proof
of relationship as father, mother, husband, wife, son, daughter, brother or sister. This proof may
be copies of birth, marriage, baptismal certificates which clearly show relationship, or a notarized
certificate.
Presentation: Once eligibility has been verified, Maine Veterans’ Services will contact primary
next-of-kin and schedule a presentation ceremony.
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