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, 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: ______________________________________
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Claimant's Relationship to Veteran: ______________________________
Please list the documents which you have included for verification of your line of descent:
______________________________ _____________________________
______________________________ _____________________________
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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.