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Veterans Wall Engraving Application Form

2. ABOUT THE VETERANS WALL
   The Veterans Wall, located at Oldsmar's Veterans Memorial Park, is engraved upon once a year. Names of those selected by the Veterans Advisory Board are read aloud during the annual Veterans Day Ceremony, held on November 11. Please complete all portions. Applications must be submitted by mid-September for consideration. A copy of the veterans discharge paper is required. Applicants will receive a letter confirming that the Veterans Advisory Board has accepted this application. For questions regarding this application, please call the City Clerk at 813-749-1115.

   The Veterans Wall, located at Oldsmar's Veterans Memorial Park, is engraved upon once a year. Names of those selected by the Veterans Advisory Board are read aloud during the annual Veterans Day Ceremony, held on November 11. Please complete all portions. Applications must be submitted by mid-September for consideration. A copy of the veterans discharge paper is required. Applicants will receive a letter confirming that the Veterans Advisory Board has accepted this application. For questions regarding this application, please call the City Clerk at 813-749-1115.

4. VETERAN INFORMATION
   (Name to be engraved)

   (Name to be engraved)

6. Last Name*

7. First Name*

8. Middle Name*

10. City Address to meet residence criteria*

    (See definition below)

12. Mailing Address (if different from above)

14. Does Veteran currently live in Oldsmar?*

    1. Yes
    2. No

15. Is Veteran deceased?*

    1. Yes
    2. No

17. Branch of Service*

18. Dates of Service*

20. Rank when Discharged*

21. Phone Number with Area Code*

23. APPLICANT INFORMATION
    (If submitting the application on Veteran's behalf):

    (If submitting the application on Veteran's behalf):

25. Name

26. Phone Number with Area Code

28. Mailing Address

30. CHECK WHICH OF THE BELOW CRITERIA APPLIES TO THIS REQUEST*

    1. United States or Canadian Military Veteran who was honorably discharged who currently lives in Oldsmar
    2. Son or Daughter who died while on active duty in the military and whose parent currently lives in Oldsmar (further documentation may be required)
    3. City employee who is a Veteran and has worked for the City at least 10 years
    4. United States or Canadian Veteran who was honorably discharged who previously lived in Oldsmar (provide proof of previous residence)

32. Date of Application*

34. DISCHARGE PAPER

    A copy of the veterans discharge paper is required. Please UPLOAD the file or call 813-749-1115 for additional options on how to submit this required document.

36. Resident of The City
    A Resident of the City shall mean a person who has physically resided within the jurisdictional limits of the City of Oldsmar for at least one year before submittal of this application to have his/her name placed on the Veterans Memorial Wall.

    A Resident of the City shall mean a person who has physically resided within the jurisdictional limits of the City of Oldsmar for at least one year before submittal of this application to have his/her name placed on the Veterans Memorial Wall.

38. Engraving Criteria
    Approved by Oldsmar City Council on February 5, 2013.

    Approved by Oldsmar City Council on February 5, 2013.

40. APPLICANT COMMENTS FOR BOARD'S CONSIDERATION:

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field