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CLAIM APPLICATION FOR CIVIL WAR MEDALS
(West Virginia Union Regiments Only)

Submission of a claim for a Union Civil War medal must be accompanied by a fifty dollar ($50.00) non-refundable payment, which includes the verification process, notification of acceptance or rejection, return of documentation, and certified mailing of the medal to successful claimants. Make checks payable to "Culture and History". Applications should be returned to: Archives and History; The Cultural Center; 1900 Kanawha Boulevard E.; Charleston, WV 25305-0300.

Name of Veteran: ____________________________________________

Veteran's Service Unit: Company ________ Regiment ___________

Names and Address of Claimant: ______________________________

_____________________________________________________________

_____________________________________________________________

Claimant's Relationship to Veteran: _________________________

Please list the documents which you have included for verification of your line of descent:

______________________________ _____________________________

______________________________ _____________________________

Briefly outline your line of descent from the veteran:

Claimant's signature: ___________________________ Date: ________


FOR USE OF CULTURE & HISTORY STAFF. PLEASE DO NOT WRITE IN THIS AREA.

Date Received: _____________ Additional documentation needed? _______

If additional documentation needed, date received: ____________

Verified: ______________ By: ___________________ Date Due: __________

Medal claims may only be submitted by mail. None will be accepted via e-mail or fax.


Civil War Medals

West Virginia Archives and History