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: ______________________________
_____________________________________________________________
_____________________________________________________________
Telephone Number: ___________________________________________E-Mail: _____________________________________________________
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: ________
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.