VETERAN biogRAphy foRm

VETERAN biography form
PLEASE PRINT. Include as much or as little
information as you wish, and use the back side of this
form or attach additional information, if necessary. This
information is used to identify the veteran’s photograph
for the Wall of Honor. You may attach a copy (not an
original) of any item you would like to include with the
biography form. All included in the biography will be
published.
Veteran’s Name: _
Submitter’s Name:
Relationship:
Branch of Service: _
Phone#:
Rank at Discharge (or current rank if now serving):_
Year Service Began: _
Year Service Ended: _
(if currently serving, write “PRESENT”)
Specialties: _
Wars or Conflicts Veteran Served in: _
Foreign Countries where the Veteran was Stationed or Served: _
Medals/Honors Received: _
Additional Information (KIA, MIA, POW, DECEASED, ETC.):
Highlights of Military Service/Important Military Experience:
USE THE BACK OF THIS FORM TO ADD ANY ADDITIONAL INFORMATION
PHOTOGRAPH AND BIOGRAPHY RELEASE
May we use your photograph and/or biographic information in publications?
Yes
No (If you check “no,” we will post your photograph on the Veterans Wall in the
Okeechobee County Elections Office ONLY and we will not use it anywhere else.)
Mailing address: _
Telephone number where you can be reached during the day:
SIGNATURE:
Date:
Return this completed form to:
DIANE HAGAN
Okeechobee County Supervisor of Elections
2nd
304 NW
St, Room 144
Okeechobee, FL 34972
Phone: (863) 763-4014  Fax: (863) 763-0152
E-mail: [email protected]
www.VoteOkeechobee.com
OFFICE USE ONLY: PHOTO RECEIPT & RETURN
Date form received:
Date photo received:
By:
Date scanned:
By: _
Photo file name:
 Photo scanned immediately and given back to owner or
(name)
 Photo dropped off by
for scanning at a later time.
Owner or a designee will pick up photo on another day.
 Photo returned via other method:_
I hereby acknowledge that the photograph of the veteran described on this form was
returned to me. If I am not the owner, I am authorized by the owner to take
possession of the photograph.
Signature of owner of photograph or designee
Office Staff Initials:
Veterans Biography Form
4/28/2015
Date