Shown below are the three medallions with the actual dimensions (+/- 1/32") for width and height. Large Medallion Dimensions: 6 3/8" W, 4 3/4" H, 1/2" D Medium Medallion Dimensions: 3 3/4" W, 2 7/8" H, 1/4" D Small Medallion Dimensions: 2" W, 1 1/2" H, 1/3" D

WHO IS ELIGIBLE - Any deceased Veteran discharged under honorable conditions, who served in the Armed Forces on or after April 6, 1917, and is buried in a private cemetery in a grave marked with a privately purchased headstone or marker. Any Servicemember of the Armed Forces of the United States who served on or after April 6, 1917, and died on active duty and is buried in a private cemetery in a grave marked with a privately purchased headstone or marker. Please attach a copy of the deceased Veteran's discharge certificate (DD Form 214 or equivalent) or a copy of other official document(s) establishing qualifying military service. If you are unable to locate copies of military records, apply anyway, as VA will attempt to obtain records necessary to make an eligibility determination. Do not send original documents; they will not be returned. Service after September 7, 1980, must be for a minimum of 24 months continuous active duty or be completed under special circumstances, e.g., death on active duty. Persons who have only limited active duty service for training while in the National Guard or Reserves are not eligible unless there are special circumstances, e.g., death while on active duty, or as a result of training. Reservists and National Guard members who, at time of death, were entitled to retired pay, or would have been entitled, but for being under the age of 60, are eligible; please submit a copy of the Reserve Retirement Eligibility Benefits Letter with the claim. Reservists called to active duty other than training and National Guard members who are Federalized and who serve for the period called are eligible

PRESIDENTIAL MEMORIAL CERTIFICATE - A Presidential Memorial Certificate (PMC) is an engraved paper certificate, signed by the current sitting president, to honor the memory of Veterans discharged under other than dishonorable conditions. If the Veteran is eligible for a headstone, marker, or medallion, one PMC will automatically be provided unless otherwise specified. Additional PMCs may be requested by indicating how many in block 18 of this form. HOW TO SUBMIT A CLAIM FAX VA Form 40-1330M and supporting documents to: 1-800-455-7143. IMPORTANT: If faxing more than one claim - fax each claim package (claim plus supporting documents) individually (disconnect the call and redial for each submission).

MAIL claims to: Memorial Products Service (41B) Department of Veterans Affairs 5109 Russell Road Quantico, VA 22134-3903 A VA medallion may be furnished only upon receipt of a fully completed and signed claim with required supporting documentation.