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IMPORTANT-- Read instructions before completing form. Detach and retain ONLY the instruction sheet. 1. FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN (Type or print) 2. DATE OF DEATH. NOTE: If the veteran's Social Security No. is unknown, complete Items 4, 5, 6, and 7 about veteran. 3. SOCIAL SECURITY NO. OF VETERAN. 4. DATE OF BIRTH 5. PLACE ...
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