DECEASED MEMBER FORM Please complete and submit for members who passed away JULY 1, 2021 – JUNE 30, 2022 This list must be submitted by JUNE 30th of each year to be included in the VSFA Convention’s Memorial Services. Names received after that date will be included the following year. PLEASE INCLUDE A PICTURE AND COMPLETE ALL INFORMATION BELOW FOR PROPER RECOGNITION. Dapartment Name* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secretary Name* First Last Phone*Email* DECEASED MEMBERS JULY 1, 2021 – JUNE 30, 2022*NameDOBDate of DeathYears of Vol. Service Click the + symbol to add additional lines.Additional InfoLife Member, Offices Held, etc.Upload Photos Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, tif, tiff, Max. file size: 2 MB.
