© 2019 Marine Corps League, Inc.
For official use by the Marine Corps League. All other use is prohibited.
Marine Corps League
Notice of Death
_________________________________of the ________________________________________
(Member Name) (Detachment Name)
Detachment #_________, Marine Corps League, did answer his/her Final Earthly Roll Call on
________________________________.
(Date of Death)
The deceased is survived by ______________________________, ________________________
(Relation’s Name) (Relationship)
who resides at ____________________________________ , ___________________________ ,
(Address) (City)
_______________ , ____________________
(State) (Zip)
Membership Number__________________ PLM Number__________________ (If Applicable)
Remarks:
A sympathy card will be sent if this notice is received within sixty (60) days from the date of
death, unless otherwise requested.
Date _________________________
Submitted by _____________________________________________
(Detachment Chaplain)
Email Address__________________________________________________________
Instructions:
1) Detachment Chaplain fills out the form then sends a copy to the Department Chaplain retaining a copy for
detachment records.
2) Department Chaplain sends a copy to the Marine Corps League National retaining a copy for department
records.
