DECEASED MEMBER FORM Please complete and submit for members who died JULY 1, 2019 – JUNE 30, 2021. This list must be submitted by August 30, 2021 to be included in the VSFA Conference Memorial Services. Names received after that date will be included the following year. PLEASE INCLUDE A PICTURE AND COMPLETE ALL INFORMATION BELOW FOR PROPER RECOGNITION. Department Name*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secretary Name* First Last Phone*Email* DECEASED MEMBERS JULY 1, 2019 – JUNE 30, 2021*NameDOBDate of DeathYears of Vol. Service Click the + symbol to add additional lines.Upload Photos Drop files here or Accepted file types: jpg, jpeg, png, pdf, tif, tiff.