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West Virginia State Archives

WVAH-11
Form #11

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 “Archives and History”.

Applications should be returned to: Archives and History; The Culture 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 ARCHIVES & 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.


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West Virginia Archives and History