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Cornelius Veterans Monument Name Application

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Steps

1. Step One This section is complete This section is incomplete
2. Proof of honorable discharge This section is complete This section is incomplete

Step One

Application for Name Inscription
First Name and Middle Initial*
Last Name*
Branch of Service*
Service Date*
Service Date
From
Service Date*
Service Date
To
Were you.......?
1. combat veteran
1. wounded in action
1. decorated for Valor
Cornelius Address*
ex. 123 Smith Lane
Residing*
Current Address
Skip this section if you are currently living in Cornelius
City
State
Zip
Contact Number*
Email Address
If application is submitted by someone other than the veteran
First/Last Name
Relationship to veteran
Contact Number
Email Address
Continue

Proof of honorable discharge

Acceptable Proof
A copy of your DD-214 or other tangible evidence must be submitted with the application in order for name to be inscribed. If you do not have proof at this time, please print the application and mail to PO Box 399, Cornelius, NC 28031 when proof is obtained.
Records Archives
Military Archives
If you do not have a copy you can obtain a copy at.
Upload
Signature*
First Initial/Last Name
Relationship*

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Email address

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21445 Catawba Avenue P.O. Box 399 Cornelius, NC 28031 Phone: 704-892-6031

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