Fl 40-40

DEPARTMENT OF VETERANS AFFAIRS

.

You are receiving this letter because
, referred to in this letter as the Reservation Holder,
has a reserved gravesite in
, at Gravesite
in Section
. The
only person authorized to use this gravesite is the Reservation Holder. The National Cemetery Administration (NCA) is required to
keep an accurate account of reserved gravesites and to make them available to other individuals if the Reservation Holder no longer
needs the gravesite.
Please complete the attached Gravesite Reservation Questionnaire by providing the following information:
-If you are replying on behalf of a Reservation Holder who is incapacitated, please indicate that in Block 5.
-If NCA did not send this letter to the Reservation Holder's current mailing address, please provide an updated address in Block 6.
-Mark your intent to keep or relenquish the reserved gravesite in Block 7.
-If you are replying on behalf of a Reservation Holder because they are deceased, please indicate that in Block 8.
Once you have completed the form – to include signing and dating it in Blocks 10 and 11 – please detach and return it using
the postage-paid envelope so that NCA can update its records. If you do not reply, NCA may cancel the reservation. Thank
you for your prompt response.
NOTE: Prior versions of this letter indicated that remarried spouses were not eligible for burial. However, in 2003 the law
changed. Surviving spouses who remarried and whose date of death is on or after January 1, 2000, are eligible for burial in any
VA national cemetery.
Contact the national cemetery listed above if you have questions. Contact information for Department of Veterans
Affairs national cemeteries is available online at https://www.cem.va.gov/cem/cems/allnational.asp .
FL 40-40
APR 2018 (RS)

DETACH HERE
OMB No. 2900-0546
Expiration Date: Xxx, 20XX
Respondent Burden: 10 minutes

GRAVESITE RESERVATION QUESTIONNAIRE (2 YEAR)
1. NAME

2. SSN/C/SERVICE NO.

3. SECTION

4. GRAVE

IF YOUR ADDRESS CHANGED, INDICATE THE CURRENT ADDRESS BELOW IN BLOCK 6.
5. ADDITIONAL INFORMATION

6. ADDRESS (Street, City, State and Zip Code)

I AM THE INDIVIDUAL LISTED IN BLOCK 1.
I AM REPLYING ON BEHALF OF THE INDIVIDUAL LISTED IN BLOCK 1.
MY RELATIONSHIP TO THE INDIVIDUAL LISTED IN BLOCK 1 IS:
(Spouse, Child, Aunt, Friend, etc.)
7. PLEASE CHECK THE APPROPRIATE BOX BELOW
YES, I WISH TO RETAIN THE RESERVED GRAVESITE
NO, I DO NOT WISH TO RETAIN THE RESERVED GRAVESITE
9. PRINT NAME
FL 40-40
APR 2018 (RS)

10. SIGNATURE

8. IS THE INDIVIDUAL IN BLOCK 1 DECEASED? (If yes, what is the
disposition of remains (scattered, buried in a private cemetery, etc.)
YES
NO
11. DATE

12. PHONE NUMBER (Include Area Code)