Officer Memorial Submission Form

Please complete this form to submit an officer’s name for possible inclusion on the Wisconsin Law Enforcement Memorial. Wisconsin Law Enforcement Memorial, Inc., will consider line of duty deaths for the annual ceremony to those that occurred prior to December 31 of the previous year, provided Wisconsin Law Enforcement Memorial, Inc., has received complete submissions no later than Feb. 1st of the current year. Wisconsin Law Enforcement Memorial, Inc., may review and approve names at any scheduled meeting held throughout the year.

Supporting documentation, including the officer's photograph, is required for all submissions. Supporting documentation includes but is not limited to the following; death certificate, agency incident report, criminal complaint, medical examiner's report, newspaper articles, etc.

Supporting documentation can be attached by clicking the "Attach Info" button near the bottom of this submission form or mail the documentation to:

Wisconsin Law Enforcement Memorial, Inc.
P.O. Box 2733,
Madison, WI 53701-2733

If you have any questions submit an email to wlem@wlem.com or call 608-846-9854.

Please review the following documents prior to submitting a name for possible inclusion on the Wisconsin Law Enforcement Memorial:

Wisconsin Law Enforcement Memorial Line of Duty Death Criteria

COVID-19 Criteria

Guidelines for Submission

First Name*

Middle Name

Last Name*

Age*

Title/Rank*

Length of Service*

Date of Death*

Date of Incident if different

Short narrative describing the incident that led to the Officer’s Death*

Agency*

Agency Phone Number*

Agency Fax Number

Chief/Sheriff’s Name*

Agency Address*

City*

State*

Zip*

Agency contact person if different than Chief or Sheriff

Contact Person Phone Number

Contact Person Email

Survivor's Information*

In an attachment or the area below, please provide the name, address, and phone of the officer's spouse, children, parents, and siblings. Please indicate if the children are minors or adults. This information will remain confidential and will not be shared with anyone without written consent. If you are unable to provide survivor information are you willing to relay information about WLEM and Memorial events to the family? I certify the information submitted is true and accurate. (please check below)

Attach Info:

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Add Info:

I certify the information submitted is true and accurate.

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Officer Memorial Submission Form

Please review the following documents prior to submitting a name for possible inclusion on the Wisconsin Law Enforcement Memorial: