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I hereby certify that the information provided is true and correct to the best of my knowledge.
I hereby certify that I buried the above-named Veteran and that the total expenses of this burial were correct as per the attached ITEMIZED bill and that the bill has been paid or annotated to indicate this allowance.
I certify that I have examined the proof of services of the deceased service person in this application, and the proof of relationship of the within named surviving spouse, and find that the statements made above are correct, and that the applicant is entitled to payment under Section 421 of the General County Code of 1929, as amended.
Montgomery County Registrar of Veterans Graves
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