Required fields are marked with asterisks (*)

Veteran Identification Program Application

First Name:

Last Name:

Home Address:

Date of Birth:

Emergency Contact Name:

Emergency Contact Phone:

Did you serve during wartime? If yes, which war:

Dates of Service:

Date of Honorable Discharge:

Military Awards:

A copy of your DD-214 needs to be sent to Town Clerk Diana Quast at townclerk@yorktownny.gov

Optional: include a photo of yourself (in uniform, if possible) to be included in a Veterans Slideshow that may be shown at veterans' events.