MISSAUKEE COUNTY VETERANS MEMORIAL PARK
Request for Inclusion of Veteran’s Name
Please provide the following information to have the name of the Veteran inscribed on a plaque to be placed in recognition of their honorable military service to our Country.
Name:______Branch of Service:______
Entry Date:______Discharge Date:______
Address at time of residence in Missaukee County:
______
Township or City of Residence:______
Name and contact info of person requesting inclusion if not the Veteran: ______
______
Please read and check two or more of the following:
□I ATTEST THAT THE ABOVE NAMES VETERAN QUALIFIES AS A RESIDENT OF MISSAUKEE COUNTY FOR A PERIOD OF AT LEAST 15 YEARS______
□OR WAS BORN IN MISSAUKEE COUNTY (Twp or City of Birth)______
□OR WHOSE PARENTS WERE RESIDENTS OF MISSAUKEE COUNTY AT THE TIME OF BIRTH OF THE VETERAN (Twp or City of Residence)______
□OR IS BURIED IN A MISSAUKEE COUNTY CEMETERY – cemetery name______
______
□AND WAS HONORABLY DISCHARGED FROM MILITARY SERVICE OR DIED DURING ACTIVE DUTY______
______
SignatureDate
Please provide a copy of the Veteran’s military service record. If it is not available, please use the attached forms to procure a copy of contact the Missaukee County Veteran’s Affairs Office for assistance. If you have an original DD 214 that has not been recorded in the Missaukee County Clerk’s office – please do that to protect your valuable record. There is no charge and they will provide free certified copies. The monument committee will be meeting on a regular basis to approve Veterans’ names. If you have questions, you may also email Raymond Moore at or Jessica Nielsen at
Turn your original application and discharge paper into:
Missaukee County Veterans Affairs OfficeMissaukee County Clerk
Raymond MooreJessica Nielsen
105 South Canal Street, P.O. Box 800111 South Canal Street, P.O. Box 800
Lake City, MI 49651 (231) 839-7839 Ext 5Lake City, MI 49651 (231) 839-4967 Ext 204
Office Hours Tues 1-4pm, Thurs 9am-1pmOffice Hours 8:30am-5:00pm Mon-Fri