Waterford Veterans Path of Honor Form (PDF)

Waterford V.F.W Post 6573
382 Boston Post Road
Waterford, Connecticut 06385
(860) 443-0442
DATE:
Buyers Information
Name (Type or Print Clearly)
Street Number and Name
Town/City and Zip Code Telephone Namber
Enter Veteran’s Information to Appear on the Brick Below
Max Number of Letters Including Spaces is 19
Name - OMIT PERIODS First MI Last Suffix (Sr, Jr)
Rank or Rating (SGT, MSG, PO1, CPO, MM2/SS) Branch of Service [US Army, US Navy, US Marines]
Career Path/Specialty [Submarine Service, Special Forces, Artillery, Amphibious]
Please Answer ALL Questions ~ Yes or No
1). Was the Veteran honorably discharged?
If not — please indicate other circumstance (KIA, DOW, POW, MIA)
2). Is the Veteran’s Service ID Number or SSN known?
3). Is the Veteran’s DD-214 accessible for review if requested?
4). Can the Veteran provide documentation of current active duty?
5). Are you purchasing a group of Family Veterans bricks? How many bricks?
Important — Please Note
© The cost per brick is $50.00. Payment is expected at the time of your application submission. Brick
placement at the Waterford Memorial will be on random placement. If you have a family of
Veterans and desire their brick to be placed in a group — please advise the committee upon payment
and application submission.
¢ Eligible Veteran’s MUST currently be OR have been a Waterford resident OR a sibling who is a
Veteran with ties to Waterford through their family.
PLEASE MAKE CHECKS PAYABLE TO: Waterford V.E.W. Post 6573 Path of Honor
Payment MUST be brought or MAILED to the Waterford V.F.W. ONLY
DO NOT WRITE IN THIS BLOCK