VA Form 40-1330M 2017-2021 - Fill and Sign Printable ...-2026

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The document provides information on how to claim a government medallion for placement on the headstone of eligible deceased veterans buried in private cemeteries. It outlines the eligibility criteria, application process, required documentation, and details about the medallion itself, including its sizes and inscriptions. The document emphasizes the importance of accurate information submission to avoid delays and includes contact information for assistance.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the name of the deceased veteran in Block 2. Ensure you include their first, middle (if applicable), last name, and suffix.
In Block 4, select the race or ethnicity of the veteran. You may choose more than one option for statistical purposes.
Indicate whether a headstone is currently in place by answering 'Yes' or 'No' in Block 3.
Fill out the veteran's service information in Blocks 7 through 11, including their Social Security number, date of birth, and branch of service.
Select the desired medallion size in Block 12 and provide your relationship to the veteran in Block 13.
Complete your contact information in Blocks 14 to 16, ensuring all details are accurate for effective communication.
Sign and date the form in Block 19 before submitting it via fax or mail as instructed on the form.

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