DMVA Form 2 "Veterans Benefits Form" - Bucks County, Pennsylvania

What Is DMVA Form 2?

This is a legal form that was released by the Pennsylvania Department of Military and Veterans Affairs - a government authority operating within Pennsylvania. The form may be used strictly within Bucks County. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Pennsylvania Department of Military and Veterans Affairs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DMVA Form 2 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Military and Veterans Affairs.

ADVERTISEMENT
ADVERTISEMENT

Download DMVA Form 2 "Veterans Benefits Form" - Bucks County, Pennsylvania

Download PDF

Fill PDF online

Rate (4.8 / 5) 18 votes
FORM #2
BUCKS COUNTY VETERANS BENEFITS
Application is hereby made for the following under Act of August 1955, P.L. 323
(
) Allowance of up to $50.00 toward base for federal marker or headstone.
1.
Full name of deceased veteran_______________________________________________________________
2.
(a) Place of Birth ______________________________(b) Date of Birth ______________________________
3.
Mark a cross (X) after branches of service in which he served. Army________Navy_____Marine Corps______
Coast Guard ______ Air Force ________
4.
Give the following information about his/her service:
ENLISTED:
Date__________________________________Place______________________________________
DISCHARGED Date_________________________________Place______________________________________
Veteran was a legal resident of the State of _____________________________at the time of enlistment.
RANK_________________________________Service Number_________________________________________
ORGANIZATIONS SERVED WITH: ________________________________________________________________
TYPE OF DISCHARGE: _________________________________________________________________________
Note: If he/she served under a name other than the one used in this application, give name under which he/she served:
____________________________________________________________
5.
Give the following information about his/her death and burial:
Death: Date _______________________Place_____________________________________________________
Burial: Date________________________Place_____________________________________________________
Mailing Address of Cemetery____________________________________________________________________
Location of Grave: Section ____________Range___________Lot_____________Grave ____________________
6.
Legal residence of veteran at the time of his/her death was at _________________________________Street
City of _____________________________________County of Bucks, Pennsylvania.
Decedent lived at that address for ________years, ______months immediately preceding death, and was a resident
Of Bucks County for a period of ________years immediately preceding death.
7.
Payment of this allowance shall be made to: ____________________________________________________
As all expenses of burial have/have not been paid. Note: Stike out word when same does not apply.
Sw orn and sub scribed before me this
_______________
Name________________________________________________
D
ay of
______________________________
20
________
Signature_____________________________________________
Address_______________________________________________
Nota ry P ublic
__________________________________
Phone #______________________Relationship______________
………………………………………………………………………………………………………………………………………………….
(To be returned by the contractor on the completion of the work)
CERTIFICATION OF ERECTION
To the Commissioners of Bucks
Doylestown, Pennsylvania:
I certify that I have erected a __foundation for a Government Marker on the grave of ________________________
at the cost of $______________, as per the Erection Authorization appearing on the reverse of this form.
Sworn and subscribed before me this ________
__________________________________
Day of _________________________20_____
(Name of Firm)
__________________________________
_______________________________________
Name
Title
(Notary Public)
Note : Payment of this account will not be made until this completed and notarized form is returned by the contractor.
If bill has already been paid, please designate party to be reimbursed.
FORM #2
BUCKS COUNTY VETERANS BENEFITS
Application is hereby made for the following under Act of August 1955, P.L. 323
(
) Allowance of up to $50.00 toward base for federal marker or headstone.
1.
Full name of deceased veteran_______________________________________________________________
2.
(a) Place of Birth ______________________________(b) Date of Birth ______________________________
3.
Mark a cross (X) after branches of service in which he served. Army________Navy_____Marine Corps______
Coast Guard ______ Air Force ________
4.
Give the following information about his/her service:
ENLISTED:
Date__________________________________Place______________________________________
DISCHARGED Date_________________________________Place______________________________________
Veteran was a legal resident of the State of _____________________________at the time of enlistment.
RANK_________________________________Service Number_________________________________________
ORGANIZATIONS SERVED WITH: ________________________________________________________________
TYPE OF DISCHARGE: _________________________________________________________________________
Note: If he/she served under a name other than the one used in this application, give name under which he/she served:
____________________________________________________________
5.
Give the following information about his/her death and burial:
Death: Date _______________________Place_____________________________________________________
Burial: Date________________________Place_____________________________________________________
Mailing Address of Cemetery____________________________________________________________________
Location of Grave: Section ____________Range___________Lot_____________Grave ____________________
6.
Legal residence of veteran at the time of his/her death was at _________________________________Street
City of _____________________________________County of Bucks, Pennsylvania.
Decedent lived at that address for ________years, ______months immediately preceding death, and was a resident
Of Bucks County for a period of ________years immediately preceding death.
7.
Payment of this allowance shall be made to: ____________________________________________________
As all expenses of burial have/have not been paid. Note: Stike out word when same does not apply.
Sw orn and sub scribed before me this
_______________
Name________________________________________________
D
ay of
______________________________
20
________
Signature_____________________________________________
Address_______________________________________________
Nota ry P ublic
__________________________________
Phone #______________________Relationship______________
………………………………………………………………………………………………………………………………………………….
(To be returned by the contractor on the completion of the work)
CERTIFICATION OF ERECTION
To the Commissioners of Bucks
Doylestown, Pennsylvania:
I certify that I have erected a __foundation for a Government Marker on the grave of ________________________
at the cost of $______________, as per the Erection Authorization appearing on the reverse of this form.
Sworn and subscribed before me this ________
__________________________________
Day of _________________________20_____
(Name of Firm)
__________________________________
_______________________________________
Name
Title
(Notary Public)
Note : Payment of this account will not be made until this completed and notarized form is returned by the contractor.
If bill has already been paid, please designate party to be reimbursed.
Instructions
1.
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.
2.
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)
3.
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.
4.
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
__________________________________________Commissioners
Page of 2