Attachment D - Appendix B - Transfer of GF Headstones-Markers-NC.pdf
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- 36C78626Q0125
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This document is an appendix form for tracking the transfer of blank government-furnished headstones, markers, and niche covers from Veterans Affairs (VA) cemetery personnel to VA contractors providing on-site inscription services.
The form documents the transfer of ten types of blank monuments and markers, including memorial wall markers in marble and granite, flat markers in marble and granite, niche covers in both materials, thin and small flat granite markers, and upright marble and granite headstones. Cemetery personnel must certify the items being transferred by entering quantities for each product type and signing the form with printed name and date. A section is provided to document any rejected items by type and quantity. The VA contractor receiving the blank items must verify receipt, confirm quantities, and countersign the form with printed name and date. This form serves as official documentation of inventory transfer and accountability between cemetery operations and the contracted inscription service provider.
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Attachment D – On-Site Inscription Services
APPENDIX B - TRANSFER OF BLANK GOVERNMENT-FURNISHED HEADSTONES,
MARKERS, OR NICHE COVERS
I certify that the blank headstones, markers, or niche covers specified below were transferred to the VA contractor listed at the bottom of the form.
Printed Name of Cemetery Personnel: ______________________________________________ Signature: _______________________________________ Date: _______________________
Check the appropriate box and insert the quantity for the type of headstone, marker or niche cover being transferred to the on-site contractor.
(A1) Memorial Wall Marker, Marble, Blank Quantity: ______
(C1) Memorial Wall Marker, Granite, Blank Quantity: ______
(F1) Marker, Marble, Blank Quantity: ______
(H1) Niche Cover, Granite, Blank Quantity: ______
(I1) Niche Cover, Marble, Blank Quantity: ______
(J1) Thin Flat Marker, Granite, Blank Quantity: ______
(L1) Small Flat Marker, Granite, Blank Quantity: ______
(U1) Headstone, Upright, Marble, Blank Quantity: ______
(V1) Headstone, Upright, Marble, Blank Quantity: ______
(W1) Headstone, Upright, Granite, Blank Quantity: ______
List any rejects below, include type and quantity:
I certify that the headstones, markers, or niche covers specified above were received by me and the quantity of items has been verified.
Printed Name of VA Contractor: __________________________________________________ Signature: _______________________________________________ Date: _______________
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