CERTIFICATION OF CEMETERY MAINTAINED IN ACCORDANCE WITH NATIONAL CEMETERY ADMINISTRATION STANDARDS
(As required by 38 CFR 39.31 and 39.81)
CERTIFICATION STATEMENT: I certify that the below named state or tribal government cemetery, assisted by a Department of Veterans Affairs grant, will be operated and maintained in accordance with the operational standards and measures of the National Cemetery Administration.
NAME AND ADDRESS OF STATE OR TRIBAL GOVERNMENT CEMETERY PROJECT FAI (Federal Application Identifier) NO.
NAME OF AUTHORIZED STATE OR TRIBAL GOVERNMENT OFFICIAL
TITLE OF AUTHORIZED STATE OR TRIBAL GOVERNMENT OFFICIAL
SIGNATURE OF AUTHORIZED STATE OR TRIBAL GOVERNMENT OFFICIAL
DATE SIGNED (mm/dd/yyyy)
VA FORM JUL 2009
40-0895-15
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