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3. Upon submittal of this application, please review the Program Guidelines for further details. The cost per paver is $125 for the paver and installation. Once you have completed this form and hit submit you will be taken to the payment screen. You can pay online or if you wish to pay by check/money order, please make payable to City of Huber Heights, and in the memo line please write Veterans Memorial Military Honors Paver Program.

   To qualify for a paver, honorees must meet the following requirements:

   • Active-duty military personnel of the United States Armed Forces; AND
   • Current Huber Heights resident or Huber Heights is an individual's hometown, OR
   • An immediate family member of a Huber Heights resident (parent, spouse, child, sibling, grandchild, child-in-law).
   • Past resident, graduate, or community leader.

   As part of the application, you MUST upload:

   • Verification of military status (Military ID or DD-214 form)

    If you have trouble with this please contact Mike Gray at 937-233-1562 or by email at mgray@hhoh.org.

5. Honoree Information*

   The name you provide will be exactly how it's displayed on the paver.

7. Branch and Dates of Military Service*

   This information is for the actual paver so provide any military service you want to display along with enlistment and discharge dates.

9. Upload verification of military status*

   Verification of military status (Military ID or DD-214 form)

11. Applicant Contact Information
13. First Name*
14. Last Name*
16. Relation to Service Person*
18. Address*
20. City*
21. State*
22. Zip Code*
24. Phone Number*
25. Email Address*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field