Veteran’s Contact

This application is for placement of a Veteran’s name on one of the ten granite monuments reserved for the Bledsoe County veteran’s. Any honorably discharged Veteran, who is from Bledsoe County or currently resides in Bledsoe County at the present time, is eligible to have his or her name placed on the wall. If the information being submitted for a Veteran is deceased, indicate the person to contact on the form below. The Veteran’s Name, Branch of Service, and Era will be placed on the Veteran’s Wall located in the Bledsoe County Veteran’s Park. Veteran friends may have their name placed on one of the granite tablets on the rock wall next to the Walk of Honor by filling out a Veterans Application Form and indicating non-Bledsoe status.

Please make sure to check your spelling of the name. The name that is input into this form will be the name that is placed on the Wall.

If you would like to View/Print the Paper Form of this document click on the link below:

Once this information has been submitted we will also need a copy of the Veteran’s DD-214 or discharge papers as well as $100.

Please mail this to:
Bledsoe Co Veteran’s Service Office
P.O. Box 575
Pikeville, TN 37367

Make checks payable to: Bledsoe Co. Veteran’s Park

For questions regarding this application form, call (423)447-6731

Veteran’s Information (Name as you want it to appear on the Wall)

First Name*

Middle Name*

Last Name*

Phone Number/Contact Number* (555-555-5555)

Email Address

Check all that apply* Check all that apply* Does Veteran Currently Live in Bledsoe County? Is Veteran Deceased?

Address*

Address

City*

State

Zip/Postal Code*

Country*

Applicant Information (If Submitting application on Veteran's Behalf) Applicant Information (If Submitting application on Veteran's Behalf) I am submitting this application on Veteran's Behalf

Mailing Address* (if different from above)

City*

State

Zip/Postal Code*

Country*

Branch of Service*

Dates of Service* (mm/dd/year)

Until* (mm/dd/year)

Check Which of the Below Criteria Applies To This Request * Check Which of the Below Criteria Applies To This Request * Military Veteran who has been honorably discharged and currently resides in Bledsoe County. Military Veteran who has been honorably discharged, a previous resident of Bledsoe County and is currently deceased Military Veteran who has been honorably discharged and was a previous resident of Bledsoe Country (Provide proof of previous residence) ** Veteran Photo in Service **

Date of Application* (mm/dd/year)

Message

11 + 6 =

**Note** If a photo of the veteran when he was in service is available, we would like to have it to publish in our book for future use at the Veteran’s Park. If you need the original back let us know and we can make a copy. **Engraving Criteria Approved by Bledsoe County Veteran’s Park Committee. ** Applicant comments for Board’s Consideration *