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Application for Burial Allowance - War Veteran, County of Westmoreland

  1. Phone (724)830-3530, Fax (724)830-3010

  2. I hereby certify that I buried the above named veteran, as herein before stated, and that the expense of the funeral was

  3. Has bill been paid in full?

  4. Your electronic signature indicates your agreement with the following statements: By typing my name in the above box and clicking the submit button I certify the above statements to be true and correct, to the best of my knowledge.

  5. Leave This Blank:

  6. This field is not part of the form submission.