(Marana & Camp Navajo only)
ARIZONA VETERANS’ MEMORIAL CEMETERY
SIERRA VISTA
PH:
FAX: 520-843-2329
AVMC-SV@AZDVS.GOV
CAMP NAVAJO
PH:
928-214-3474
FAX: 928- 752-2775
AVMC-CN@AZDVS.GOV
DECEDENT NAME: __________________ ___________________ ___________________________ ____
(Legal name) First last suffix
middle
Date of birth __________
Widowed
SSN# ____________________ Date of death ___________
Gender: M F Marital Status: Married Divorced
Never Married Unknown
Relationship Veteran (Non-Veteran Spouse or Eligible Dependents) A fee is required prior to service.
Place of residence: ________________________________________________________________________________
Place of residence at the time of death: City, State, Zip code, County of decedent
FUNERAL HOME (If applicable): __________________________ Contact _________________ Phone ______________
LEGAL NEXT OF KIN __________________________________________ Relationship _________________________
DOB:( spouse only) _____________________ SSN# (spouse only) __________________________________________
Mailing Address_________________________________________________________________________
City ___________________________________ State __________________
Zip code ______________
Phone _____________
Email address: _____________________________
Is the Legal Next of Kin (NOK) making the arrangements? Yes No If no, provide Name_________________ Phone _______________
Please provide power of attorney paperwork/Designation of representation, if other than Legal NOK.
Is the spouse a veteran (provide Discharge document(s)? Yes No If yes, does the surviving spouse want a separate gravesite? Yes No
VETERAN: _______________________________ ________________________ __________________________________________ _____
First middle last
suffix
SSN# ________________ Date of birth ____________
Do you have a copy of the military discharge(s)? Yes No (Must be legible and show Branch, Rank, Character of service, and Entry/Exit dates)
INTERMENT TYPE: Casket (In-Ground) Columbarium Wall/Niche (Cremains) In-Ground/Burial (Cremains)
Is the casket oversized? Yes No Material Type of Urn/ Casket? _________________________
Are there any previous interments? Yes No Name____________________________ Date of birth _______________
Request for Military honors? Yes No (Funeral Home is responsible for scheduling Military Honors and providing burial flag)
Requested date and time for service: ___________________________________________________
(Eligibility must be determined prior to scheduling. Services offered Monday- Friday excluding State and Federal Holidays)
PLEASE SEND COMPLETE MILITARY DOCUMENTS
Military documentation (DD214 etc.) and marriage certificate and or death certificate is required to determine eligibility and for awards and highest rank
held. Information on this form will also be used to order the monument. Please ensure that spelling and dates are accurate. I have certified that the above
information is correct and the decedent/veteran has not committed a capital crime or serious sex offense under Federal or State law.
SIGNATURE: ______________________________________ DATE: ______________________
(Next of Kin or Legal representative)
---------------------------------------For Cemetery Use Only (Do Not Complete)-----------------------------------------------
VETERAN: _______________________________ ________________________ __________________________________________ _____
First middle last
suffix
Service# __________________________ SSN# _________________________
Military Status: Veteran Retired Military Active Duty
Branch of Service: Army Air Force Navy Marine Corps Coast Guard Other __________________
ACTIVE DUTY DATES: Entry ______________________ Discharge ______________________ Highest Rank______________
Entry ______________________ Discharge ______________________ Highest Rank______________
Veterans Chapel (Sierra Vista Only)
SERVICE DETAILS: Committal Shelter
None
PROCESSION: Scheduled services w/ family____ Direct-to-witness ____ Direct (No witness) ____ 1
st
/ 2
nd
SCHEDULING: Day _______________ Date_______________ Time _______________
Section ___________ Row __________ Site _________ Verified Docs_________ Verified by: _______
APPLICATION OF INTERMENT
Revised
11/3/2021
MARANA
PH:
520-638-4869
FAX: 520-300-8403
AVMC-M@AZDVS.GOV
520-458-7144
CLEAR FORM
Submit form
Submit form
Submit form
click to sign
signature
click to edit
For Cemetery Use Only
STATE CEMETERY
Interment Statem
ent for Divided Cremated Remains
INSTRUCTIONS: CEMETERY STAFF
INSERT CEMETERY AND DECEDENTS NAME
NEXT OF KIN (OR AUTHORIZED REPRESENTATIVE)
SIGN AND DATE
I understand that Arizona Veterans Memorial Cemetery is accepting
the divided cremated remains of:
______________
__ _____________ ___________________ for interment
(Decedent’s Full Name)
I further understand that none of the retained/removed cremains will be added
later to the gravesite or original container being interred at this state cemetery.
By placing a portion of our loved one’s cremated remains in this VA state
cemetery, I understand that any remaining cremated remains are not eligible for
interment or memorialization in any other VA national or state cemetery.
In addition, I understand that no matter the future disposition of the remaining
cremated remains, i.e., interment in a private cemetery or scattering, my loved
one is not authorized to receive an additional Government-furnished headstone,
marker or niche cover.
_________________________________ _______________
Next of Kin Signature Date
To Be Completed By
Cemetery Staff
NOK Printed Name: ________________________________________________
Relationship to Decedent: ___________________________________________
**CREMATED REMAINS ONLY**
click to sign
signature
click to edit
MARKER INSCRIPTION WORKSHEET
LAST NAME: ________________________________________________________
FIRST NAME & INITIAL: ________________________________________________________
(include suffix, ie. Jr., Sr., II, III)
RANK: __________________________ BRANCH: ______________________________
WAR TIME: ________________________________________________________
BIRTH DATE: __________________________ DEATH DATE: __________________________
Upright Granite marker- casketed Optional Additional Inscription:
Flat granite marker- in-ground cremated remains optional inscriptions:
PLEASE NOTE DOCUMENTATION MUST BE PROVIDED FOR NOTABLE AWARDS. WAR PERIODS
AND AWARDS ARE OPTIONAL AND REQUIRES ADDITIONAL LINES.
A NEW MARKER WILL BE ORDERED FOR ALL SUBSEQUENT INTERMENTS.
Signature of next of kin: _______________________________________ Date: __________________
EMBLEM OF BELIEF: _____________________________________ MAJOR AWARDS: ____________
(Purple Heart, Bronze Star, Silver Star)
Columbaruim Wall marker - cremated remains Optional Additional Inscription :
____________
----Due by the date of interment ----
click to sign
signature
click to edit
Updated July 2021
Arizona State Veteran Cemetery
Check list
Complete and sign the Application of Interment required areas. If this is a casket interment,
please work directly with your funeral home director.
Send a legible copy of military discharge document(s) (Generally this will be the DD214 form,
Honorable Separation from Active duty, Veteran Affairs certificate of service etc.) The
document(s) must show the veteran’s name, dates of active duty military service, and character
of service.
If married, send copy of the marriage certification or death certificate (This document will verify
the spouse’s eligibility for interment at the veteran’s cemetery)
If spouse is a military veteran, a copy of their military discharge document(s).
The Funeral home is responsible for scheduling military honors. (In the case of the funeral home
not being involved, contact AVMC staff for assistances)
The Burial US Flag is to be given to the family by the funeral home. If not, contact your local
post office and they will provide a burial flag free of cost. Fill out VA Form 27-2008 Application
for United States Flag for Burial, along with a copy of discharge document(s).
Interment fee of $________ has been paid by online payment option, check or money order
made out to AVMC (Non-veteran spouse or eligible dependent interments only)
The Marker Inscription form must be completed and submitted to cemetery staff no later than
the day of service. Send in the all cemetery and supporting documents to:
SIERRA VISTA
PH: 520-458-7144
FAX: 520-843-2329
AVMC-SV@AZDVS.GOV
MARANA
PH: 520-638-4869
FAX: 520-300-8403
AVMC-M@AZDVS.GOV
CAMP NAVAJO
PH: 928-214-3479
FAX: 928-752-2775
AVMC-CN@AZDVS.GOV
Please call to verify receipt of documents.
Funeral Directors and next of kin (NOK) are responsible for scheduling clergy,
honor guards and bagpipers that will be part of the Committal Service. In the
absences of the Funeral Home Director, cemetery personnel can schedule
military honors.
ADDITIONAL INSCRIPTION EXAMPLES
BELOVED HUSBAND AND FATHER
TWO HEARTS REJOINED
LOVED HUSBAND DAD & GRANPA
TILL WE MEET AGAIN
(GRAMPA or GRAMPY or PAPA or OPA or UPPA)
HUSBAND FATHER GRANDFATHER
HUSBAND DAD GRAND & GREAT
HUSBAND DAD BROTHER & SON
HUSBAND & DAD NOT FORGOTTEN
BELOVED HUSBAND & SOUL MATE
WONDERFUL LOVING HUSBAND
LOVING DAD ETERNAL SPOUSE
FATHER GRANPA GREAT GRANPA
GREATEST DAD IN THE WORLD
BELOVED MOTHER GRANDMOTHER
(GRANDMA or GRAMMY or NANA or NANNY or OMA)
GOD GRANT ME SERENITY
CARING LOVING MAN & FATHER
A GREAT MAN & FATHER
A MAN OF FAITH ALIVE IN CHRIST
A MEMORABLE JOURNEY
A SON NEVER FORGETS
STORY TO TELL HAND TO GIVE
A WONDERFUL FRIEND
ABIDE IN ME AND IN YOU
ACTA NON VERBA --IN PEACE & WAR (ACTION NOT
WORDS)
ADVOCATE FOR THE ABUSED
GO HAND IN HAND WITH GOD
ALWAYS A GENTLEMAN
ALWAYS A HELPING HAND
ALWAYS CHERISHED
ALWAYS DID THE RIGHT THING
AN ANGEL SENT TO ALL
AWAITING RESURRECTION
BECAME A MARINE AT AGE 17
BEST FRIEND & LOVING FATHER
BLUE ANGEL 5 GONE HOME
CELEBRATING IN ETERNITY
COMPLETED LIFE’S JOURNEY
CONDUCTED LIFE HIS OWN WAY
DEDICATED TO GOD & FAMILY
GOD BE WITH YOU UNTIL WE MEET
FAITHFUL MISSIONARY
GOD BLESS AMERICA
GRACIOUS LADY IN PINK
GREAT--OUTDOORSMAN
HE LIVED LIFE ON HIS TERMS
HE NEVER MET A STRANGER
HERO TO FAMILY & COUNTRY
HIS IRISH SPIRIT LIVES ON
HIS LITTLE BRIDE
HONEST & PATRIOTIC
HOW GREAT THOU ART
I COR 13 IS HOW HE LIVED
IN LOVING REMEMBRANCE
IN THE ARMS OF JESUS & MARY
KIND & GENTLE SPIRIT
WINGS OF FREEDOM
LOVE & SPIRIT SHINE THROUGH
LOVE LAUGHTER FRIEND TO ALL
VICTORIOUS IN LIFE
LOVED BEYOND DESCRIPTION
LOVED UNCONDITIONALLY
USAF CIVILIAN AWARD FOR VALOR
LOVED SO MUCH FINALLY HOME
MISSED BEYOND BELIEF·
IN OUR HEARTS FOREVER
MY SPIRIT LIVES FOREVER
NEVER GIVE UP ON LIFE
NOW IN HIS SERVICE
NURSE CARING IN HEAVEN
OUR ANGEL FROM GOD RETURNED
PEACEFULLY HONORING GOD
PEARL HARBOR SURVIVOR
REMEMBERED WITH LOVE
REST WITH GOD BELOVED
BELOVED SYMPHONY OF LIFE
ROLL WITH THE PUNCHES
SERVANT OF GOD PROV 31:10-31
SERVANTS HEART LOVED BY ALL
SERVED IN LUZON & NEW GUINEA
SPECIAL KIND & GENEROUS MAN
STRONG LOVING GIVER OF LIFE
WIND BENEATH OUR WINGS
THE LORD IS MY SHEPHERD
THINK BEYOND THE MOMENT
TO HONOR WITH DIGNITY
UNDER THE ANGEL’S PROTECTION
All exceptions at director’s discretion
ADDITIONAL INSCRIPTION EXAMPLES
1 THESS 4:13-18
2ND JOHN 8-11
FRIEND TO ALL
A GENTLE MAN
A GENTLE SOUL
A GRAND LADY
A GREAT MAN
HEART OF GOLD
SMILING HEART
TRUE PATRIOT
ADORED FATHER
ADORED MOTHER
GIVER OF LIFE
GENTLE PATRIOT
GOD’S HANDS
ALWAYS A LADY
ALWAYS LOVED
ANGEL OF GOD
REST WITH GOD
BEST FRIEND
BORROWED GIFT
BRAVE HEART
CARING FATHER (MOM)
CARING MOTHER
CHRISTIAN SOUL
DEAR SON & HERO
DEARLY LOVED (MISSED)
DEVOTED FATHER
DEVOTED FRIEND
DEVOTED MOTHER
DEVOUT CATHOLIC
DR OF EDUCATION
SAILED ON HOME
ETERNAL SPOUSE
FAMILY HERO
FATHER TOO MANY
FINALLY HOME
FISHIN WITH GOD
FOREVER AT PEACE
FOREVER LOVED
FOREVER MISSED
FORMER MAYOR
FREE AT LAST
FREE MASON
FREE SPIRIT
FRIEND OF JESUS
FRIEND TO ALL (MANY)
GOD BLESS HER
GONE FISHING
IN LOVING MEMORY
GRACIOUS LADY
GREAT FISHERMAN
GREATLY LOVED (MISSED)
HE GAVE ALL
HE KEPT SMILING
HERO TO FAMILY
HOME AT LAST
HONEST & TRUE
HONORABLE HERO
HONORED VETERAN
I AM WHAT I AM
JAMAIS ARRIERE (NEVER
BEHIND)
JOHN 3:16
JOINED FOREVER
JOSHUA 24: 15
SCHOOLTEACHER
LlFE LONG LOVE
LIVED TO SERVE
LOST AT SEA
LOVE IS ENDLESS
SEEKER OF TRUTH
LOVED & ADMIRED
LOVED & HONORED
LOVED BY ALL (MANY)
LOVED FISHING
LOVED IN CHRIST
LOVED SO MUCH
MAN OF GOD
MASTER MASON
MISSED BY ALL (MANY)
MUSIC IN HEAVEN
NEVER FORGOTTEN
NOT FORGOTTEN
GENEROUS HEART
PSALMS 23
PRECIOUS MOTHER
PRECIOUS TO ALL
PROUD AMERICAN
PROV 31:10-31
RACE CAR GRAMPA
REST IN PEACE
REST PEACEFULLY
FRIEND TO DOGS
SEMPER FI
SEMPER FIDELlS
SEMPER PARA TIS
SERVANT OF GOD
SERVANTS HEART
SERVED PROUDLY
SOLDIER OF TIME
SORELY MISSED
FOREVER IN OUR HEARTS
SPECIAL FRIEND
SPECIAL PAPA
STILL LAUGHING
STRONG & LOVING
SWEET WOMAN (MAN)
LOVING COUPLE
LOVING PARENTS
THIS IS MY HOME
TOGETHER ALWAYS (AGAIN)
UNASSUMING HERO
TRUE BLUE
TRUE FAMILY MAN
TRUE FRIEND
TRUE PATRIOT
TRUE SOLDIER
TRULY LOVED
LOVING FATHER
WE LOVE YOU
AT PEACE
HE COMPLETED LIFE’S JOURNEY