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INSTRUCTIONS FOR COMPLETING APPLICATION FOR BURIAL ...
21. FULL NAME AND ADDRESS OF THE FIRM, CORPORATION, OR STATE AGENCY FILING AS CLAIMANT WITNESS TO SIGNATURE IF MADE BY "X" NOTE - If claimant signed above using an "X", signature must be witnessed by two persons to whom the person making the statement is personally known, and the signatures and€addresses of such witnesses must be …
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INSTRUCTIONS FOR COMPLETING ENROLLMENT …
www.veteransaidbenefit.orgwill take to read instructions, gather the necessary facts and fill out the form. Please Read Before You Start . . . What is VA Form 10-10EZ used for? SERVICE-CONNECTED (SC): A VA determination that an illness or injury was incurred or aggravated in the line of duty, in the ... Report last illness and burial expenses, e.g., prepaid burial, paid ...
INFORMATION AND INSTRUCTIONS TO HELP YOU …
www.veteransaidbenefit.orgVA will no longer give out benefit or claim information (except for the information VA has already given out based on your permission). VA FORM SEP 2016. 21-0845. At VA, we recognize and respect the importance of privacy. Personal information that we collect is kept confidential to the extent provided by law.
VETERAN'S SUPPLEMENTAL CLAIM FOR COMPENSATION
www.veteransaidbenefit.orgveteran's supplemental claim for compensation. 3. va file number. important: please read the privacy act notice and respondent burden information below before completing this form. va date stamp do not write in this space. 5. telephone number(s) € € 4. veteran's address (number, street or rural route, city or p.o., state and zip code)
REQUEST FOR NURSING HOME INFORMATION IN …
www.veteransaidbenefit.orgSection I - VETERAN/CLAIMANT'S IDENTIFICATION INFORMATION SECTION III - GENERAL INFORMATION€(To be completed by a Nursing Home Official) NOTE: You can either complete the form online or by hand. If completed by hand, print the information requested in ink, neatly, and legibly to expedite processing the form.
FV13 - CARE PROVIDER CERTIFICATION OF SERVICES
www.veteransaidbenefit.orgCARE PROVIDER CERTIFICATION OF SERVICES (FORM FV13) Instructions for Filling out this Form The purpose of this form is to provide the Department of Veterans Affairs (VA) with detailed
NOTICE TO VETERAN/SERVICE MEMBER OF …
www.veteransaidbenefit.orgFor adapting and/or purchasing a residence. To support a claim for . service connection based upon a period of active duty for training, the evidence must show:€ ...
Supportive Services for Veteran Families (SSVF) Program
www.veteransaidbenefit.orgwill provide a range of supportive services to eligible Veteran families that are designed to promote housing stability. The statutory authority for the SSVF Program is found at 38 U.S.C. 2044.
INCOME AND ASSET STATEMENT IN SUPPORT OF CLAIM …
www.veteransaidbenefit.orgA natural or adoptive parent has custody of a child unless custody is legally removed. For pension purposes, a child who has attained age 18 remains in the custody of the person who had custody before the child turned age 18 unless custody is legally removed. ** Parent's DIC claimants do not need to report or provide documentation of their assets.
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First Name Last Name Benefit Amount Last Known Address ...
www.oregon.govFirst Name Last Name Benefit Amount Last Known Address City State ZIP JUDY AARON Between $50 and $100 PO BOX 798 HEPPNER OR 97836 MAX ABBOTT Under $50 324 N 1680 E APT 13B SAINT GEORGE UT 84790 SUSAN ABBOTT Under $50 1017 6TH ST NW SALEM OR 97304 AAGOT ABRAHAMSON Under $50 21540 S UPPER HIGHLAND RD …
Survivor's Benefit Program - Eligibility of Retired ...
www.osc.state.ny.usSURVIVOR’S BENEFIT PROGRAM Eligibility of Retired Employee for Survivor’s Benefit RS 6355 ... any amount payable on my behalf should be paid to the following. If I have named more than one beneficiary, it is my intention ... _____, before me personally appeared _____ to me known and known to me to be the same person described in and who ...
DEPARTMENT OF LABOR & INDUSTRY COMPENSATION …
www.uc.pa.govThe employer’s complete mailing address, phone and fax number, email address, and employer UC account number, if known First and last dates you worked for this employer Gross earnings during your last week of employment, if available Reason you left or, if still working, the reason you are working fewer hours
Individual Indian Money (IIM) Instructions for ...
www.doi.govLast Address of Record IIM Account Number Approximate Date and Amount of the Last Disbursement. NOTE: If identity is not verified, refer account holder to BTFA Field Office to make changes in person or by mail.
MODIFIED BENEFIT FORMULA QUESTIONNAIRE - …
www.ssa.govADDRESS (include postal code) 2. Is the pension listed in item 1 a partial benefit paid under a U.S. Social Security (Totalization) agreement? Yes. If "yes," submit evidence such as an award certificate or letter from the agency paying the pension, ignore the rest of the form, and sign your name on the last page in the appropriate space. No
Labor Standards Complaint Form
dol.ny.govBenefit Owed B. Time Period Benefit Earned C. Date Benefit Payment Due D. Amount of Benefit Time Owed E. Amount of Benefit Payment Due F. Benefit Promised by: Ex.: Vacation pay 1/1/1612/31/16– 1/1/17 1 week $700 written policy verbal promise written policy verbal promise written policy verbal promise written policy verbal promise G. Total Part 7.
Form 8886 (Rev. December 2019) - IRS tax forms
www.irs.govName(s) shown on return (individuals enter last name, first name, middle initial) Identifying number. Number, street, and room or suite no. City or town. State ZIP code. A . If you are filing more than one Form 8886 with your tax return, sequentially number each Form 8886 and enter the statement number for this Form 8886 . . . . . . . Statement ...
Proof of Claim - United States Courts
www.uscourts.govB10 (Official Form 10) (04/13) UNITED STATES BANKRUPTCY COURT _____ District of _____ PROOF OF CLAIM Name of Debtor: Case Number: COURT USE ONLY NOTE: Do not use this form to make a claim for an administrative expense that arises after the bankruptcy filing.You may file a request for payment of an administrative expense according to 11 U.S.C. § 503.