ARIZONA ARMY NATIONAL GUARD FUNERAL HONORS REQUEST
Phone Number: (602) 629-4310
You can download and electronically complete this form at:
https://dema.az.gov/army-national-guard/arizona-military-honors
We are closed on weekends and Federal holidays. All requests received on weekends/holidays will not
be processed until the next business day.
Fax DD Form 214 or Honorable Discharge Certificate and this form to: (602) 267-2461
or return via email to: ng.az.azarng.mbx.mfh@mail.mil
Part One: Information - Deceased Veteran
Name of Deceased Veteran:
,
,
(last) (first)
(MI)
Branch of Service:
U.S. ARMY
_
Date of Birth: Social Security #: - -
(MM/DD/YYYY)
Retired from Military Service?
Yes
No Rank (if known):
SELECT
Who will the flag be presented to? Relationship to Veteran:
Address: City: State: Zip:
Personal Information is collected in accordance with DA Form 4475.
Part Two: Funeral Home or Family POC Information
Name of Funeral Home: Email Address:
Requestor:
Address:
Phone #:
- -
Cell #:
-
- Fax #: - -
Do you have a flag to present?
Yes
No
(If the funeral home does not supply the interment flag the person requesting honors is responsible to get the flag
from the Post Office or VA)
Part Three: Funeral Honors Location (i.e. cemetery, church, etc.)
Date:
(MM/DD/YYYY)
Time:
PM
Type of service to be provided:
Casket Cremation
Memorial
Location Name:
Address:
City:
State: Select
Indicate any other special requests (example: Commissioned Officer or military relative to present the
flag):
CONTROL/MISSION #: _____________________________________ (MFH USE ONLY)
NMHR-FORM-AZ-1 rev. 1
Zip Code
