Type Full Name :
Sign With Hand
ZIP
Are you a member of a local Veteran’s organization, i.e., VFW, American Legion, DAV? If yes, which organization?
Attachments
State
Requestor
City
City
State
First Name
Highest Military Award
Address
I acknowledge that all statements made herein are accurate and that this application will not be accepted as submitted until all required documents are remitted.
How would you like to be awarded?
Would you be interested in volunteering at Veterans Services for future events?
Is This A Posthumous Award?

COUNTY OF BERGEN
DEPARTMENT OF HUMAN SERVICES
DIVISION OF VETERANS SERVICES
One Bergen County Plaza •2nd Floor•
Hackensack, NJ 07601-7076
(201) 336-6325 • FAX (201) 336-6327
veterans@co.bergen.nj.us

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Application must be completed and submitted with a copy of the following:

  • If discharged prior to January 1, 1951, the following separation papers must be attached to the application:

• U.S. Army: WSAGO 53-55
• U.S. Navy & U.S. Coast Guard: NAVPERS 553
• U.S. Marine Corps: NAVMC 790

  • If discharged after January 1, 1951, a copy of the DD Form 214 must be attached to the application.
  • Posthumous Medals will be awarded subject to the above requirements including a copy of a death certificate or obituary showing that the deceased veteran was a Bergen County resident at the time of his or her death.
Relationship to Veteran
Briefly describe your job in the military
Service Date To

Bergen County Military
Service Medal Requirements

• Veteran must currently reside in Bergen County.
• Veteran must have an Honorable Discharge.
• Application must be completed and submitted with a copy of the following:

  • If discharged prior to January 1, 1951, the following separation papers must be attached to the application:

• U.S. Army: WSAGO 53-55
• U.S. Navy & U.S. Coast Guard: NAVPERS 553
• U.S. Marine Corps: NAVMC 790

  • If discharged after January 1, 1951, a copy of the DD Form 214 must be attached to the application.
  • Posthumous Medals will be awarded subject to the above requirements including a copy of a death certificate or obituary showing that the deceased veteran was a Bergen County resident at the time of his or her death.


Questions? Call the Division of Veterans Services at 201-336-6325.

Last Name
Regulations
Military Occupation
Address
Veteran Information
Last Name
If Other, please provide details
Certification
Rank
Are you applying on behalf of a Veteran?
ZIP
Attachments
Service Date From
Phone #
Phone #
Email
First Name
Signature
Email
Branch