Louisiana Veterans Cemeteries Interment Application

Decedent Information

First Name*
Middle Name
Last Name*

SS #*
Date of Death*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY

Gender*
- Male
- Female
Type*
- Veteran
- Dependent

Status*
- Single
- Married
- Divorced
- Separated
- Widowed
Branch of Service*
- Army
- Navy
- Air Force
- Marine Corps
- Coast Guard
- Space Force
- Dependent/Spouse
Highest Rank of Veteran

Interment Type (choose one): Funeral homes are responsible for lowering private vaults.*

Columbarium Wall (Cremated)
In-Ground (Cremated)
State-Provided Grave Liner (Casketed)
Private Vault (Casketed)

Will the casket or vault be oversized?*
- Yes
- No
Oversize casket or vault dimensions: (L x W x D)*

Is the decedent to be interred in the same gravesite as a previously interred spouse or eligible dependent?*

Yes
No

If yes, what is the name of the previous decedent?

Will a spouse or eligible dependent be interred with decedent in future?*

Yes
No

If Yes*

Casketed
Cremated

Is the Spouse a Veteran?*
- Yes
- No

Type of religious emblem desired on marker

Personalized marker inscription (Beloved Father, Loved By All, etc.):

Select desired cemetery location for interment*

Other Information

Funeral Home Information

Funeral Home Name
Fax

Phone
Cell Phone

Mailing Address
Parish/County

City
Select State
Zipcode

Point of Contact

Next of Kin Information

First Name*
Middle Name
Last Name*

Relationship to Decendent*
SS # (required for spouse only)
Phone*

Email*
Date of Birth*
MM slash DD slash YYYY

Mailing Address*
Parish/County*

City*
Select State*
Zipcode*

Honors Information (Veterans Only)

Funeral Director has arranged for Military Honors – If Eligible

Yes
Family Requests none

Funeral Director has arranged for flag to be presented by this active branch of service:

PLEASE UPLOAD A COPY OF MOST RECENT DISCHARGE/SEPARATION FORM DD 214*

Drop files here or

Max. file size: 40 MB.

Other Notes:

If decedent is not the veteran, a $745 fee must be assessed.
The Funeral Director is responsible for verifying marriage documents to insure the eligibility of spouses.
Please ensure that no more than three (3) floral arrangements are delivered to the cemetery for the committal service.
A Provisional Burial Transit Permit must accompany all casketed remains.
By submitting this form I accept and agree with all VA regulations for burial.

Additional paperwork may be required.

An LDVA representative will be in touch if further paperwork is required to complete your application.

Louisiana Department of Veterans Affairs

Step 1 of 2

Decedent Information

Funeral Home Information

Next of Kin Information

Honors Information (Veterans Only)

Other Notes:

Additional paperwork may be required.

Please review your entry and submit the form.

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Louisiana Veterans Cemeteries Interment Application

Step 1 of 2

Decedent Information

Funeral Home Information

Next of Kin Information

Honors Information (Veterans Only)

Other Notes:

Additional paperwork may be required.

Please review your entry and submit the form.

Still have Questions?