Information about http://www.defiance-county.com/Defiance%20County%20Veterans%20Directory.pdf
Defiance County Veterans Directory…
Tags: birth country, birth date, birth parent, birth state, burial service, campaigns, county veterans, date of birth, death place, defiance county, information branch, jr sr, maiden name, middle name, military service, separation units,Pages: 2
Language: english
Created: Thu Jun 26 01:38:30 2003
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Defiance County Veterans Directory
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Last Name ______________________ First Name_______________________ Middle Name________________
Maiden Name ___________________ Spouse's Name _____________________________ Jr. / Sr.__________
Date of Birth ____________________ Parent's Names ______________________________________________
City of Birth _____________________ County of Birth ___________________ State of Birth ________________
Country of Birth _______________________________________________________________________________
Date of Death ___________________ City of Death ____________________ County of Death ______________
State of Death ___________________ Country of Death _____________________________________________
Place of Burial ________________________________________________________________________________
Service Information
Branch of Service _______________________________ Military Service No. _______________________
Date Entered Service ____________________________ Date of Separation ________________________
Site of Enlistment _______________________________ Site of Separation _________________________
State of Enlistment ______________________________ State of Separation ________________________
Units in Which Served ___________________________ Highest Rank Held ________________________
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War/Campaigns______________________________________________________________________________
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Awards & Decorations________________________________________________________________________
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8/2/200 (Rev. 3-01-01)
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Information Source/Remarks/Comments Where did you get this information from?
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Attach a copy of the military discharge (DD214) to this form, if available.
Name of Person turning this form in: _____________________________________________________
Complete Address: ____________________________________________________________________
Telephone Number with Area Code ______________________________________________________
SEND OR FAX THIS FORM TO:
Defiance County Veteran's Affairs
Attn: Tanya S. Brunner
197-1B Island Park Avenue
Defiance, OH 43512
Office Phone 419-782-6861
Fax 419-782-6713