Sacramento Valley National Cemetery
PLEASE CALL US BY THE DATE LISTED ON THE PINK SHEET Upright Marble Monument - SPOUSE/ DEPENDENT / NO VETERAN
Sacramento Valley National Cemetery 5810 MIDWAY ROAD DIXON, CA 95620 PHONE: (707) 693-2460 FAX: (707) 693-2479 This worksheet is a guide to order the marker. Please return the completed form to the cemetery via fax or you may call with the information. This information is needed by the date on the pink paper in your information packet. After 7 days we are required to order only the basic information*. *Items in bold are required on VA markers.
EMBLEM OF BELIEF ---------------------à 1.
*FIRST NAME (INITIAL, MIDDLE NAME / INITIAL)
2.
5.
*LAST NAME
4.
FULL MIDDLE NAME
3.
Monument Sample not to scale
MONTH DAY *YEAR OF BIRTH
MONTH DAY *YEAR OF DEATH
8.
*VETERAN LAST NAME & BRANCH OF SERVICE
9.
ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
6.
7.
RELATIONSHIP LINE
*VETERAN RANK & FIRST NAME
10. ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
11. ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
Date of Service
NOK Signature
SVNC Form 2 - UPRIGHT MARBLE MONUMENT – SPOUSE / DEPENDENT / NO VETERAN, FEB 2017 (All other forms are obsolete)
Sacramento Valley National Cemetery 5810 MIDWAY ROAD DIXON, CA 95620 PHONE: (707) 693-2460 FAX: (707) 693-2479 This worksheet is a guide to order the marker. Please return the completed form to the cemetery via fax or you may call with the information. This information is needed by the date on the pink paper in your information packet. After 7 days we are required to order only the basic information*. *Items in bold are required on VA markers.
EMBLEM OF BELIEF ---------------------à 1.
*FIRST NAME (INITIAL, MIDDLE NAME / INITIAL)
2.
5.
*LAST NAME
4.
FULL MIDDLE NAME
3.
Monument Sample not to scale
MONTH DAY *YEAR OF BIRTH
MONTH DAY *YEAR OF DEATH
8.
*VETERAN LAST NAME & BRANCH OF SERVICE
9.
ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
6.
7.
RELATIONSHIP LINE
*VETERAN RANK & FIRST NAME
10. ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
11. ADDITIONAL INSCRIPTION (15 CHARACTERS INCLUDING SPACES)
Date of Service
NOK Signature
SVNC Form 2 - UPRIGHT MARBLE MONUMENT – SPOUSE / DEPENDENT / NO VETERAN, FEB 2017 (All other forms are obsolete)
