
Assigned Command must confirm with Navy Region Midwest and funeral home.
***FOR OFFICIAL USE ONLY - Privacy Sensitive - Any misuse or unauthorized disclosure may result in either civil or criminal penalties.***
U.S. NAVY FUNERAL HONORS REQUEST FORM
2601B Paul Jones St., Bldg 1, Great Lakes, IL 60088
Funeral Honors Office: (847) 688-2414 OR (877) 478-3988
or fax request to: (847) 688-2454/2463
DD 214 OR DISCHARGE CERTIFICATE MUST ACCOMPANY THIS REQUEST
Please allow 48 hours advance notice.
DATE OF HONORS: TIME OF HONORS: TIME ZONE: URN CASKET OTHER (i.e. memorial service)
NAME: LAST, FIRST, MIDDLE:
SERVICE:
NAVY MERCHANT
MARINE
STATUS: VETERAN
RETIRED
ACTIVE DUTY
SSN: RATE/RANK: DATE OF BIRTH: DATE OF DEATH:
PART II WHERE WOULD YOU LIKE THE HONORS TO BE RENDERED?
CEMETERY CHURCH FUNERAL HOME OTHER (Specify) ____________________
NOTE: Honor Guard reports 45 minutes prior.
LOCATION NAME: PHONE:
ADDRESS: COUNTY:
CITY: STATE: ZIP:
PART III NEXT OF KIN INFORMATION
NAME OF PERSON TO RECEIVE FLAG: RELATION TO DECEASED:
ADDRESS: PHONE:
CITY: STATE: ZIP:
PART IV MORTUARY/ FUNERAL HOME INFORMATION
NAME OF FUNERAL HOME: POINT OF CONTACT:
ADDRESS: PHONE: FAX:
CITY: COUNTY: STATE: ZIP:
*** FUNERAL HOME WILL
PROVIDE FLAG ***
VALID EMAIL ADDRESS: