The Louisiana Veterans Honor Medal Eligibility Criteria Form - Louisiana

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Honoring the Sacrifice and Service of Our Veterans
The Louisiana Veterans Honor Medal
Eligibility Criteria
Veteran served in the U.S. armed forces during wartime or peacetime
Veteran received an honorable discharge or died prior to separation
Veteran is a current Louisiana resident, was a LA resident upon entering military service, or
was a LA resident at the time of death.
For military personnel killed on active duty, attach DD Form 1300/death certificate.
Veteran’s Information:
Name: _____________________________________________________________________
Deceased
Killed in Action
Purple Heart Recipient
Prisoner of War
Living
Street Address: ______________________________________ Parish: ___________________
City: ________________________________ State: ________ Zip Code: _________________
Email Address: _____________________________________ Phone: (_____)_____________
Branch of Service: _________________ Rank Held upon Discharge: ____________________
Entered Active Duty: ____________/______/________ Exited: __________/______/________
Month
Day
Year
Month
Day
Year
:
Applicant Information
(for those applying on behalf of a veteran; one medal per veteran)
Name: _______________________________________________________________________
Street Address: _______________________________________ Parish:___________________
City: _______________________________ State: _______ Zip Code: __________________
Email Address: _____________________________________ Phone: ___________________
Relationship to Veteran: ________________________________________________________
Please mail application and
DD Form 214/discharge papers
to:
LDVA, P.O. Box 94095, Baton Rouge, LA, 70804.
bayouvets.com
Honoring the Sacrifice and Service of Our Veterans
The Louisiana Veterans Honor Medal
Eligibility Criteria
Veteran served in the U.S. armed forces during wartime or peacetime
Veteran received an honorable discharge or died prior to separation
Veteran is a current Louisiana resident, was a LA resident upon entering military service, or
was a LA resident at the time of death.
For military personnel killed on active duty, attach DD Form 1300/death certificate.
Veteran’s Information:
Name: _____________________________________________________________________
Deceased
Killed in Action
Purple Heart Recipient
Prisoner of War
Living
Street Address: ______________________________________ Parish: ___________________
City: ________________________________ State: ________ Zip Code: _________________
Email Address: _____________________________________ Phone: (_____)_____________
Branch of Service: _________________ Rank Held upon Discharge: ____________________
Entered Active Duty: ____________/______/________ Exited: __________/______/________
Month
Day
Year
Month
Day
Year
:
Applicant Information
(for those applying on behalf of a veteran; one medal per veteran)
Name: _______________________________________________________________________
Street Address: _______________________________________ Parish:___________________
City: _______________________________ State: _______ Zip Code: __________________
Email Address: _____________________________________ Phone: ___________________
Relationship to Veteran: ________________________________________________________
Please mail application and
DD Form 214/discharge papers
to:
LDVA, P.O. Box 94095, Baton Rouge, LA, 70804.
bayouvets.com

Download The Louisiana Veterans Honor Medal Eligibility Criteria Form - Louisiana

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