Fillable Printable VA Form 40-1330
Fillable Printable VA Form 40-1330
VA Form 40-1330
GENERAL INFORMATION SHEET
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. VA cannot conduct or sponsor a collection of information unless it has a valid OMB number. Your obligation to respond is voluntary,
however, your response is required to obtain benefits. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to the VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420. Please DO NOT
send claims for benefits to this address.
BENEFIT PROVIDED
a. HEADSTONE OR MARKER
Only for Veterans who died on or after November 1, 1990 - Furnished for the grave of any eligible deceased Veteran. Will be provided for
placement in private cemeteries regardless of whether or not the grave is already marked with a privately-purchased headstone or marker.
Only for Veterans who died before November 1, 1990 - Furnished for the UNMARKED GRAVE of any eligible deceased Veteran. The
applicant must certify the grave is unmarked. For Veterans that served prior to World War I, a grave is considered marked when a
headstone/marker displays the decedent's name only, or if the name was historically documented in a related document, such as by a
number that is inscribed on a grave block and is recorded in a burial ledger. For service during and after World War I, a grave is
considered marked if a headstone/marker displays the decedent's name and date of birth and/or death, even though the Veteran's military
data is not shown.
b. MEMORIAL HEADSTONE OR MARKER - Furnished for placement in a cemetery only to commemorate a deceased eligible Veteran
whose remains have not been recovered or identified, were buried at sea, donated to science, or cremated and the remains scattered. May not be
used as a memento. Check box in block 28 and explain in block 27.
c. MEDALLION - Eligible Veterans may receive a Government-furnished headstone or marker, or a medallion, but not both. If requesting a
medallion, please use VA Form 40-1330M.
WHO IS ELIGIBLE - Any deceased Veteran discharged under honorable conditions and any member of the Armed Forces of the United States who dies on
active duty. A deceased Veteran discharged under conditions other than honorable may also be eligible. A copy of the deceased Veteran's discharge
certificate (DD Form 214 or equivalent) or a copy of other official document(s) establishing qualifying military service must be attached. Do not send
original documents; they will not be returned. Service after September 7, 1980, must be for a minimum of 24 months continuous active duty or be
completed under special circumstances, e.g., death on active duty. Persons who have only limited active duty service for training while in the National
Guard or Reserves are not eligible unless there are special circumstances, e.g., death while on active duty, or as a result of training. Reservists and National
Guard members who, at time of death, were entitled to retired pay, or would have been entitled, but for being under the age of 60, are eligible; a copy of the
Reserve Retirement Eligibility Benefits Letter must accompany the claim. Reservists called to active duty other than training and National Guard members
who are Federalized and who serve for the period called are eligible. Service prior to World War I requires detailed documentation, e.g., muster rolls,
extracts from State files, military or State organization where served, pension or land warrant, etc.
WHO CAN APPLY - Federal regulation defines "applicant" as the decedent's Next-of-Kin (NOK); a person authorized in writing by the NOK; or a personal
representative authorized in writing by the decedent. Written authorization must be included with claim. A notarized statement is not required.
HOW TO SUBMIT A CLAIM
FAX claims and supporting documents to 1-800-455-7143.
IMPORTANT: If faxing more than one claim - fax each
claim package (claim plus supporting documents) individually, i.e.,
disconnect the call and redial for each submission.
MAIL claims to: Memorial Programs Service (41B)
Department of Veterans Affairs
5109 Russell Road
Quantico, VA 22134-3903
A Government headstone or marker may be furnished only upon receipt of a fully completed and signed claim with required supporting documentation.
SIGNATURES REQUIRED - The applicant signs in block 17; the person agreeing to accept delivery (consignee) in block 22, and the cemetery or other
responsible official in block 24. If there is no official on duty at the cemetery, the signature of the person responsible for the property listed in block 21 is
required. Entries of "None," "Not Applicable," or "NA" cannot be accepted. State Veterans' Cemeteries are not required to complete blocks 17, 18, 22 and
23.
ASSISTANCE NEEDED - If assistance is needed to complete this claim, contact the nearest VA Regional Office, national cemetery, or a local veterans'
organization. No fee should be paid in connection with the preparation of this claim. Use block 27 for any clarification or other information you wish to
provide. Should you have questions when filling out this form, you may contact our Applicant Assistance Unit toll free at: 1-800-697-6947, or via e-mail at
.
TRANSPORTATION AND DELIVERY OF MARKER - The headstone or marker is shipped without charge to the consignee designated in block 19 of
the claim. The delivery will not be made to a Post Office box. The consignee should be a business with full delivery address and telephone number. If the
consignee is not a business explain fully in block 27. For delivery to a Rural Route address, you must include a daytime telephone number including area
code in block 20. If you fail to include the required address and telephone number information, we cannot deliver the marker. The Government is not
responsible for costs to install the headstone or marker in private cemeteries.
CAUTION - To avoid delays in the production and delivery of the headstone or marker, please check carefully to be sure you have accurately furnished all
required information before faxing or mailing the claim. If inaccurate information is furnished, it may result in an incorrectly inscribed headstone or
marker. Headstones and markers furnished remain the property of the United States Government and may not be used for any purpose other than to be
placed at an eligible individual's grave or in a memorial section within a cemetery.
DETACH AND RETAIN THIS GENERAL INFORMATION SHEET FOR YOUR RECORDS.
VA FORM
FEB 2014
40-1330
ALL PREVIOUS VERSIONS OF THIS FORM WILL BE OBSOLETE ON OCTOBER 1, 2014
ILLUSTRATIONS OF STANDARD GOVERNMENT HEADSTONES AND MARKERS
UPRIGHT HEADSTONE
WHITE MARBLE OR
LIGHT GRAY GRANITE
This headstone is 42 inches long, 13 inches wide
and 4 inches thick. Weight is approximately 230
pounds. Variations may occur in stone color, and
the marble may contain light to moderate veining.
BRONZE NICHE
This niche marker is 8-1/2 inches long,
5-1/2 inches wide, with 7/16 inch rise.
Weight is approximately 3 pounds;
mounting bolts and washers are
furnished with the marker. Used for
columbarium or mausoleum interment.
Also provided to supplement a
privately-purchased headstone or
marker for eligible Veterans who died
on or after November 1, 1990 and are
buried in a private cemetery.
FLAT MARKERS
BRONZE
This grave marker is 24 inches long, 12 inches wide, with 3/4 inch
rise. Weight is approximately 18 pounds. Anchor bolts, nuts and
washers for fastening to a base are furnished with the marker. The
base is not furnished by the Government.
LIGHT GRAY GRANITE OR WHITE MARBLE
This grave marker is 24 inches long, 12 inches wide, and 4 inches
thick. Weight is approximately 130 pounds. Variations may occur
in stone color; the marble may contain light to moderate veining.
NOTE: Civil War Era headstones - In addition to the headstone and markers pictured, two special styles of upright headstones are available for those who
served with Union Forces during the Civil War or for those who served in the Spanish-American War, and another for those who served with the
Confederate States of America during the Civil War. Requests for these special styles should be made in block 27 of the claim. It is necessary to submit
detailed documentation that supports eligibility. Inscriptions on these headstone types are intentionally limited to assure historic accuracy. For example,
only rank above 'Private' was historically authorized; emblems of belief and the words 'Civil War' are not provided.
INSCRIPTION INFORMATION
MEMORIAL HEADSTONES AND MARKERS (remains are not buried). The words "In Memory Of" are mandatory and precede the authorized
inscription data. The words "In Memory Of" are only inscribed when remains are not available.
MANDATORY ITEMS of inscription at Government expense are: Legal Name, Branch of Service, Year of Birth, Year of Death, and for State
Veterans and National Cemeteries only, the section and grave number. Branches of Service are: U.S. Army (USA), U.S. Navy (USN), U.S. Air Force
(USAF), U.S. Marine Corps (USMC), U.S. Coast Guard (USCG), U.S. Army Air Forces (USAAF), and other parent organizations authorized for certain
periods of time; and special units such as Women's Army Auxiliary Corps (WAAC), Women's Air Force Service Pilots (WASP), U.S. Public Health Service
(USPHS), and National Oceanic & Atmospheric Administration (NOAA). Different examples of inscription formats are illustrated above. More than one
branch of service is permitted, subject to space availability.
OPTIONAL ITEMS are identified on the claim in boxes with bold outlines. These items may be included at Government expense if desired. Optional
items include month and day of birth in block 5A, month and day of death in block 5B, highest rank attained in block 7, awards in block 9, war service in
block 10, and emblem of belief in block 12. War service includes active duty service during a recognized period of war and the individual does not have to
serve in the actual place of war, e.g., Vietnam may be inscribed if the Veteran served during the Vietnam War period, even though the individual never
served in the country. Supporting documentation must be included with the claim if you wish to include the highest rank and/or awards.
ADDITIONAL ITEMS may be inscribed at Government expense if they are requested on the initial claim and space is available. Examples of
additional items include appropriate terms of endearment, nicknames (in expressions such as "OUR BELOVED POPPY"), military or civilian credentials or
accomplishments such as DOCTOR, REVEREND, etc., and special unit designations such as WOMEN'S ARMY CORPS, ARMY AIR CORPS, ARMY
NURSE CORPS or SEABEES. All requests for additional inscription items should be stated in block 27, and are subject to VA approval. No graphics,
emblems or pictures are permitted except available emblems of belief, the Medal of Honor, and the Southern Cross of Honor for Civil War Confederates.
RESERVED SPACE for future inscriptions at private expense, such as spousal or dependent data, is allowed if requested in block 27 and if space is
available. Only two lines of space may be reserved on flat markers due to space limitations. Reserved space is unnecessary on upright marble or granite
headstones as the reverse side is available for future inscriptions.
INCOMPLETE OR INACCURATE INFORMATION ON THE CLAIM MAY RESULT IN ITS RETURN TO THE CLAIMANT, A DELAY IN RECEIPT OF THE
HEADSTONE OR MARKER, OR AN INCORRECT INSCRIPTION.
Form approved, OMB No. 2900-0222
Expiration Date: Feb. 18, 2017
Respondent Burden: 15 minutes
IMPORTANT: Please read the General Information Sheet before completing this form. Type or
print clearly all information except for signatures. Illegible printing could result in an incorrect
headstone or marker or delivery. Blocks outlined in bold are optional inscription items. Unless
indicated otherwise all other blocks must be completed. MILITARY DISCHARGE DOCUMENTS
OR RELATED SERVICE INFORMATION ARE REQUIRED.
1. FOR VA USE ONLY
2. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (NO NICKNAMES OR TITLES PERMITTED)
FIRST (Or Initial) MIDDLE (Or Initial) LAST SUFFIX
3. GRAVE IS:
CURRENTLY MARKED
(with privately purchased marker)
NOT MARKED
VETERAN'S SERVICE AND IDENTIFYING INFORMATION (Use numbers only, e.g., 05-15-1941)
4. VETERAN'S SOCIAL SECURITY NO. OR SERVICE NO.
SSN: OR SVC. NO.:
5A. DATE OF BIRTH
MONTH DAY YEAR
5B. DATE OF DEATH
MONTH DAY YEAR
PERIODS OF ACTIVE MILITARY DUTY (For additional space use Block 27)
6A. DATE(S) ENTERED
MONTH
DAY YEAR
6B. DATE(S) SEPARATED
MONTH DAY YEAR
7. HIGHEST RANK ATTAINED (No pay grades)
8. BRANCH OF SERVICE (Check applicable box(es) - must be consistent with rank in Box 7)
ARMY
NAVY
MARINE
CORPS
COAST
GUARD
AIR FORCE
ARMY
AIR FORCES
MERCHANT
MARINE
OTHER
(Specify)
9. VALOR OR PURPLE HEART AWARD(S) (Documentation must be provided)
MEDAL OF
HONOR
DST SVC
CROSS
NAVY
CROSS
AIR FORCE
CROSS
SILVER
STAR
BRONZE
STAR
MEDAL
PURPLE
HEART
OTHER
(Specify)
10. WAR SERVICE (Check applicable box(es))
WORLD
WAR II
KOREA VIETNAM
PERSIAN
GULF
OTHER
(Specify)
11. TYPE OF HEADSTONE OR MARKER REQUESTED (Check one)
FLAT
BRONZE
B
FLAT
GRANITE
G
UPRIGHT
MARBLE
U
FLAT
MARBLE
F
BRONZE
NICHE
Z
UPRIGHT
GRANITE
V
12. DESIRED EMBLEM OF BELIEF
NONE
EMBLEM NUMBER
(Specify) (See reverse side of this form for available emblems)
13A. NAME AND MAILING ADDRESS OF APPLICANT
(No., Street, City, State, and ZIP Code)
13B. DAYTIME PHONE NO. OF APPLICANT
14. E-MAIL ADDRESS (Optional)
15. FAX NO. (Optional)
16. ARE YOU:
NEXT OF KIN (Specify relationship)
AUTHORIZED REPRESENTATIVE ON
BEHALF OF DECEDENT (Include Written
Authorization)
AUTHORIZED REPRESENTATIVE ON BEHALF OF
NEXT OF KIN (Include Written Authorization)
CERTIFICATION: By signing below I certify the headstone or marker will be installed in the cemetery listed in block 21 at no expense to the Government and all
information entered on this form is true and correct to the best of my knowledge. I also certify, to the best of my knowledge, that the decedent has never committed
a serious crime, such as murder or other offense that could have resulted in imprisonment for life, has never been convicted of a serious crime, and has never been
convicted of a sexual offense for which he or she was sentenced to a minimum of life imprisonment.
PENALTY: The law provides severe penalties, which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material
fact, knowing it to be false or for the fraudulent acceptance of any benefit to which you are not entitled.
17. SIGNATURE OF APPLICANT 18. DATE (MM/DD/YYYY)
19. NAME AND DELIVERY ADDRESS OF BUSINESS (CONSIGNEE) THAT WILL
ACCEPT PREPAID DELIVERY (No., Street, City, State, and ZIP Code); P.O. BOX
IS NOT ACCEPTABLE
20. DAYTIME PHONE NO.
(Include Area Code)
21. NAME AND ADDRESS OF CEMETERY WHERE
GRAVE IS LOCATED (No., Street, City, State, and
ZIP Code)
CERTIFICATION: By signing below I agree to accept prepaid delivery of the headstone or marker.
22. PRINTED NAME AND SIGNATURE OF PERSON REPRESENTING BUSINESS (CONSIGNEE) NAMED IN BLOCK 19 23. DATE (MM/DD/YYYY)
CERTIFICATION: By signing below I certify the type of headstone or marker checked in block 11 is permitted in the cemetery named in block 21.
24. PRINTED NAME AND SIGNATURE OF CEMETERY OR OTHER RESPONSIBLE
OFFICIAL
25. DAYTIME PHONE NO. (Include Area Code) 26. DATE (MM/DD/YYYY)
27. REMARKS (Additional inscription space will vary in size according to the type of marker)
28. CHECK BOX BELOW IF REMAINS ARE NOT BURIED AND EXPLAIN IN BLOCK 27
(e.g., buried at sea, remains scattered, etc.)
REMAINS NOT BURIED
29. SECTION/GRAVE NO. (State Cemetery Only)
VA FORM
FEB 2014
40-1330
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
ALL PREVIOUS VERSIONS OF THIS FORM WILL BE OBSOLETE ON OCTOBER 1, 2014
AVAILABLE EMBLEMS (See block 12)
The graphics shown below are of 20 representative emblems of belief for placement on Government-furnished headstones/markers.
EMBLEMS OF BELIEF AVAILABLE:
LATIN CROSS (01)
BUDDHIST (Wheel of Righteousness) (02)
JUDAISM (Star of David) (03)
PRESBYTERIAN CROSS (04)
RUSSIAN ORTHODOX CROSS (05)
LUTHERAN CROSS (06)
EPISCOPAL CROSS (07)
UNITARIAN CHURCH (Flaming Chalice) (08)
UNITED METHODIST CHURCH (09)
AARONIC ORDER CHURCH (10)
MORMON (Angel Moroni) (11)
NATIVE AMERICAN CHURCH OF NORTH AMERICA (12)
SERBIAN ORTHODOX (13)
GREEK CROSS (14)
BAHAI (9 Pointed Star) (15)
ATHEIST (16)
MUSLIM (Crescent and Star) (17)
HINDU (18)
KONKO-KYO FAITH (19)
COMMUNITY OF CHRIST (20)
SUFISM REORIENTED (21)
TENRIKYO CHURCH (22)
SIECHO-NO-IE (23)
THE CHURCH OF WORLD MESSIANITY (lzunome) (24)
UNITED CHURCH OF RELIGIOUS SCIENCE (25)
CHRISTIAN REFORMED CHURCH (26)
UNITED MORAVIAN CHURCH (27)
ECKANKAR (28)
CHRISTIAN CHURCH (29)
CHRISTIAN & MISSIONARY ALLIANCE (30)
UNITED CHURCH OF CHRIST (31)
HUMANIST (AMERICAN HUMANIST ASSOCIATION) (32)
PRESBYTERIAN CHURCH (USA) (33)
IZUMO TAISHAKYO MISSION OF HAWAII (34)
SOKA GAKKAI INTERNATIONAL - USA (35)
SIKH (KHANDA) (36)
WICCAN (37)
LUTHERAN CHURCH MISSOURI SYNOD (38)
NEW APOSTOLIC CHURCH (39)
SEVENTH DAY ADVENTIST CHURCH (40)
CELTIC CROSS (41)
ARMENIAN CROSS (42)
FAROHAR (43)
MESSIANIC JEWISH (44)
KOHEN HANDS (45)
CATHOLIC CELTIC CROSS (46)
THE FIRST CHURCH OF CHRIST, SCIENTIST (Cross and
Crown) (47)
MEDICINE WHEEL (48)
INFINITY (49)
LUTHER ROSE (51)
LANDING EAGLE (52)
FOUR DIRECTIONS (53)
CHURCH OF NAZARENE (54)
HAMMER OF THOR (55)
UNIFICATION CHURCH (56)
SANDHILL CRANE (57)
MUSLIM (Islamic 5 Pointed Star) (98)
To obtain the most recent information about headstones and markers including the complete and most current list of available emblems of
belief (listing all names and graphics), please visit our website at www.cem.va.gov
. You may also request a copy of this list by contacting
our Applicant Assistance Unit toll free at 1-800-697-6947, or via e-mail at: [email protected].
VA FORM 40-1330, FEB 2014
