Veterans Memorial Application

Antwerp Veterans Memorial Application

Veterans who would like to be included on the granite tablets at the Vets Memorial in Riverside Park may complete and submit the application shown below. Engravings are done once per year in November so any new applications for engravings should be turned into the Village by October 1st of each year. After submitting the application, please mail a $75.00 check or money order made payable to “Village of Antwerp” along with a copy of the veteran’s discharge paperwork, to Village of Antwerp, Attn: Vets Memorial, P.O. Box 1046, Antwerp, OH 45813

Name: *

First

Middle

Last

Date of Induction: *

Date of Discharge: *

Type of Discharge: *

Branch of Service: *

Proof of Antwerp Local School District: *

Former Resident Address:

Complete this section if you chose "Former Resident" above.

Current Resident Address:

Complete this section if you chose "Current Resident" above.

AHS Graduate - Class of:

Complete this section if you chose "AHS Graduate" above.

On which tablet would you like the name engraved? *

Cost is $75, unless it is a new discharge (within 1 year of discharge): *

If new discharge, please list date:

Telephone Number: *

If further information is required, we will contact you at this number.

Email Address: *

Phone