Wis. Stats. Chapter 45	Submission of an electronic application with uploaded documents through the MyWisVets.com online portal will result in the fastest processing time. Alternatively, paper applications may be submitted by mail to: STATE OF WISCONSIN, DEPARTMENT OF VETERANS AFFAIRS 2135 Rimrock Road, P.O. Box 7843 Madison, WI 53713-7843 Or by fax at: (608)-267-0403
PRE-REGISTRATION FOR CEMETERY INTERMENT — APPLICATION
Please check the appropriate box on application to establish eligibility of a veteran for interment at one of the state veteran’s cemeteries: Spooner, Union Grove, or King. Follow registration procedures regarding submission of military service, residency and/or marriage documentation. Once eligibility has been established, you will receive pre-registration confirmation of your request.
CEMETERY PRE-REGISTRATION
Please enter your e-mail address below:
Your E-mail Address:
PREFERRED VETERANS CEMETERY (you are not obligated to this choice)
Please select one: Spooner (NWVMC), King (CWVMC), Union Grove (SWVMC)
VETERAN APPLICANT PERSONAL INFORMATION
Last Name	Suffix I II III IV Jr. Sr.	First	Middle Name
Present Street Address:
City	County	State	Zip
Home Phone:	Work Phone:
Date of Birth (mm/dd/yyyy)	Social Security Number	Gender Male Female	Marital Status Single Married Divorced Widowed Legally Separated
Service Type: (Type of interment can be changed at a later date.) Casket Cremation
SPOUSE APPLICANT PERSONAL INFORMATION: (Complete only if pre-registering for spouse.)
Last Name	Suffix I II III IV Jr. Sr.	First	Middle Name
Check if you are a veteran or current military member
Date of Birth (mm/dd/yyyy)	Social Security Number	Gender Male Female	Marital Status Single Married Divorced Widowed Legally Separated
Service Type: (Type of interment can be changed at a later date.) Casket Cremation
VETERAN’S MILITARY SERVICE INFORMATION
Branch of Service: (Must be consistent with rank.) Army Marine Corps Navy Air Force Coast Guard Merchant Marine Other
Period of Service: (Check applicable box(es).)
Persian Gulf	Vietnam	Korea	World War II	National Guard or Reserves (20 years of	Other
qualifying service or retired)
Service / Social Security Number:	Highest Rank Attained:
PERIODS OF ACTIVE DUTY MILITARY SERVICE: (If more than 3 active duty periods, enter the longest.)
First Service Period Entry Date (mm/dd/yyyy)	Separation Date (mm/dd/yyyy)	Second Service Period Entry Date (mm/dd/yyyy)	Separation Date (mm/dd/yyyy)
Third Service Period Entry Date (mm/dd/yyyy)	Separation Date (mm/dd/yyyy)
I certify that all information I have provided on this application and the supporting documentation is true and correct to the best of my knowledge.
SIGNATURE OF APPLICANT:	DATE: