Veterans Monument Application Page 1 of 2
(Revised 3/22/2021)
City of Irwindale
Veterans Monument
Application
Any American Veteran, living or deceased, who served in the U.S. Armed Forces, received an
honorable discharge, and lived in Irwindale at some point during his or her lifetime, or made a
significant contribution to the Irwindale community (such as an employee or volunteer), as
determined by the City Council, is eligible to have his or her name on the Irwindale Veterans
Monument. Applications are accepted on a continuous basis. Only those applications received by
June 30 of the application year and confirmed with a copy of a DD214 or other legal
documentation verifying branch, rank and honorable discharge will be inscribed and honored at
the following Annual Veterans' Day Ceremony*.
Please forward the application and all documents to:
Irwindale City Hall/Administration
5050 N. Irwindale Avenue
Irwindale, CA 91706
Select one of the following:
City of Irwindale Resident (Complete Sections A, B, & D)
Non-Irwindale Resident Applicant (Complete Sections A, C, & D)
SECTION A: VETERAN INFORMATION
List name as it is to appear on the monument:
Last Name First Name Middle Name or Initial
Branch Last Rank Date of Service
Phone No.: E-Mail:
Select one of the following and provide the required information:
Address at the time of entry Address at the time of discharge
Address City State
Type of Discharge: Service No/SSN:
Comments:
Office Use:
Date Rec’d:
By:
