Fillable State of Minnesota Department of Veterans Affairs (Minnesota)

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State of Minnesota Department of Veterans Affairs (Minnesota)

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State of Minnesota – Department of Veterans Affairs
Military Funeral Honors Stipend Request, July 1 – June 30
MDVA HGR (06/20) The Military Funeral Honors Stipend Request Form can be found at: https://mn.gov/mdva/memorials/militaryfuneralhonors.jsp
A Veterans Service Organization (VSO) should submit this form to request a stipend for performing military
funeral honors. The responsibility for proper completion and submission of this form rests with the VSO.
Stipend will not exceed $50.00 from the Minnesota Department of Veterans Affairs for each honors being
provided.
• Requests are preferred within 15 days of honors being provided.
• The VSO is responsible for obtaining the mandatory signatures from the Honor Guard Leader
and the Funeral Director.
• Service for each veteran must be verified by DD-214. Do not submit a DD-214 with this form.
• An incomplete form will be returned to the VSO.
PART ONE: VSO Performing Honors
Honor Guard Unit: SWIFT Vendor #:
Unit Address: City & Zip:
Point of Contact (please print): Phone #:
Honors performed (check box that apply):
Full Honors (Rifle Detail, Taps, Flag Folding) ☐ Basic Honors (Flag Folding, Taps)
Signature of Honor Guard Leader: Date:
PART TWO: Information – Deceased Veteran ☐ DD-214 Form Confirmed
Name of Veteran Last: __________________________ First: ___________________ M: ________
Date Honors Performed: Date of Birth:
Location of Honors: City: County:
Branch of Service: ☐U.S. Army ☐ U.S. Navy ☐ U.S. Coast Guard
☐ U.S. Marine Corps ☐ U.S. Air Force ☐ Merchant Marine
PART THREE: Funeral Director Verification (to be completed by the Funeral Director)
Were the military honors performed in an acceptable manner? ☐ Yes ☐ No
Name of Funeral Home:
City: Phone #:
Funeral Director Printed Name:
Funeral Director Signature: Date:
Mail or fax this form to: MDVA, Fiscal Services, Accounts Payable Coordinator, Veterans Service
Bldg, 20 West 12
th
St, St Paul, MN 55155. Office: (651) 296-2562 Fax: (651) 757-1575
For Office Use Only PAYMENT INFORMATION
Amount:
_________
Input Date:
__________
Voucher #:
________________
Entered By:
Approved by:________________________________________________ Date: ____________________________
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Additional Military Funeral Honors (copy as needed – must attach to completed page 1)
MDVA HGR (06/20) The Military Funeral Honors Stipend Request Form can be found at: https://mn.gov/mdva/memorials/militaryfuneralhonors.jsp
Honor Guard Unit: SWIFT Vendor #:
☐ Full Honors (Rifle Detail, Taps, Flag Folding) ☐ Basic Honors (Flag Folding, Taps)
PART TWO: Information – Deceased Veteran ☐ DD-214 Form Confirmed
Name of Veteran Last: _______________________________ First: ___________________ M: __________
Date Honors Performed: Date of Birth:
Location of Honors: City: County:
Branch of Service: ☐U.S. Army ☐ U.S. Navy ☐ U.S. Coast Guard
☐ U.S. Marine Corps ☐ U.S. Air Force ☐ Merchant Marine
PART THREE: Funeral Director Verification (to be completed by the Funeral Director)
Were the military honors performed in an acceptable manner? ☐ Yes ☐ No
Name of Funeral Home:
City: Phone #:
Funeral Director Printed Name:
Funeral Director Signature: Date:
For Office Use Only PAYMENT INFORMATION
Amount:
_________
Input Date:
__________
Voucher #:
________________
Entered By:
Approved by:________________________________________________ Date: ____________________________
☐ Full Honors (Rifle Detail, Taps, Flag Folding) ☐ Basic Honors (Flag Folding, Taps)
PART TWO: Information – Deceased Veteran ☐ DD-214 Form Confirmed
Name of Veteran Last: _______________________________ First: ____________________ M: _________
Date Honors Performed: Date of Birth:
Location of Honors: City: County:
Branch of Service: ☐U.S. Army ☐ U.S. Navy ☐ U.S. Coast Guard
☐ U.S. Marine Corps ☐ U.S. Air Force ☐ Merchant Marine
PART THREE: Funeral Director Verification (to be completed by the Funeral Director)
Were the military honors performed in an acceptable manner? ☐ Yes ☐ No
Name of Funeral Home:
City: Phone #:
Funeral Director Printed Name:
Funeral Director Signature: Date:
For Office Use Only PAYMENT INFORMATION
Amount:
_________
Input Date:
__________
Voucher #:
________________
Entered By:
Approved by:________________________________________________ Date: ____________________________
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State of Minnesota – Department of Veterans Affairs
Military Funeral Honors Stipend Request, July – June 30
MDVA HGR (06/20) The Military Funeral Honors Stipend Request Form can be found at: https://mn.gov/mdva/memorials/militaryfuneralhonors.jsp
Instructions to apply for the benefit
A local unit of a congressionally chartered Veterans Service Organization (VSO) or its auxiliary is
eligible under Minnesota Statute Chapter 197 Honor Guards [197.231] to receive a stipend of up to $50
for each time the local unit provides an honor guard detail at the funeral of a deceased veteran. If the
local unit provides a student to play “Taps,” the local unit may pay some or all the stipend to the student.
To be eligible to receive the reimbursement:
• The VSO must have registered as a state supplier and received a SWIFT (Statewide Integrated
Financial Tools) vendor ID number. Instructions on how to obtain your current or new SWIFT
vendor ID number can be found at:
https://mn.gov/mmb/accounting/swift/vendor-resources/
• If you have any question regarding vendor registration, please contact
SWIFT helpline at 651-201-8106 or 651-201-8100
• Services must be for a veteran whose service has been verified by DD-214 through the funeral
director. If assistance is required to verify service, contact your County Veterans Service Officer.
Do not submit DD-214’s with the Military Funeral Honors Stipend Request.
• The VSO is responsible for obtaining all original signatures and submitting the Military Funeral
Honors Stipend Request.
• The VSO is required to submit a Military Funeral Honors Stipend Request, which will verify that
the veterans group, post or chapter has performed honors on a given date.
Forms should be submitted within 15 days of honors performed.
Forms should be mailed to the address listed on the form or faxed to: (651) 757-1575.
• The VSO must perform honors in accordance with the National Defense Act of 2000 (Public Law
106-65.) Military funeral honors detail shall, at a minimum, perform at the funeral a ceremony that
includes the folding and presentation of the U.S. flag and play “Taps,” either by a high-quality
recording or by a bugler. The law defines a military funeral honors detail as two or more former or
active uniformed military persons, with at least one being a member of the veteran's branch of
military service. Additional honors such as a firing (rifle) detail may be provided if resources are
available.
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State of Minnesota Department of Veterans Affairs (Minnesota)

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Completed 9 September 2020

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