APPLICATION: PRE-REGISTRATION FOR BURIAL DETERMINATION
This application is used to assist the cemetery in determining eligibility for interment at the Arizona Veterans Memorial Cemetery. An Interment Application is
required to be completed at the time of need. There is no cost for pre-need determination, and it does not obligate the veteran to be interred at the cemetery. This
information will be kept on file until the time of need.
SECTION 1: VETERAN INFORMATION
First Name ___________________ Middle ______________ Last ____________________________ Suffix (Jr, Sr) _____
Address __________________________________________ City ________________________ State __________________
County __________________________________ Zip code _______________ Phone ( ______)_________-_____________
Date of Birth (mm/dd/yyyy): _______/_____/_____________ Social Security #: _______--________--_________
Gender: Male Female Marital Status: Married Single Divorced Widowed
Interment Preference: Cremated Casketed Unknown at this time
SECTION 2: SERVICE RECORD
Branch of Service: ______________ Highest Rank: ____________ Service Number (if applicable) _____________________
Date(s) Entered: _____/______/__________ Date(s) Separated: ______/_______/__________
SECTION 3: SPOUSE INFORMATION
First Name _________________________ Middle ______________ Last _________________________________________
Date of Birth (mm/dd/yyyy): ______/_____/_______ Social Security #: ________--______--__________
Do you anticipate that your spouse will be buried at the cemetery? Yes No
(If spouse is a veteran, please submit a separate application)
Signature of Applicant: ______________________________________________ Date: ________/_________/_________
Email address: ______________________________________________________
Contact information other than Applicant
Name ________________________________ Phone (_____)______-_______ Relationship ________________________
Please include Copies of the following documents with your application (do not send originals): 09/08/2014
• Veteran’s Military Discharge. (DD-214 or equivalent).
• If married and spouse elects to be buried in the cemetery, a copy of the marriage certificate.
• Marriage certificate still required for dual veteran couple status
(Cemetery Use Only)
Mail or Fax application and supporting documents to the following
address:
Southern Arizona Veterans Memorial Cemetery
1300 Buffalo Soldiers Trail
Sierra Vista, Arizona 85650
Email: SAVMC@AZDVS.GOV
PH: 520-458-7144
FX: 520- 458-7147
ARIZONA DEPARTMENT OF VETERANS’ SERVICE
ARIZONA VETERANS’ MEMORIAL CEMETERY at:
Sierra Vista Marana Camp Navajo
Approved Denied
Reason denied _____________________________________
_______________________
____________________________
Date: ___/____/______ Verifying Doc__________________
SAVMC Staff: ____________________________________
