Page 12 - VASurvivorsKit_Neat
P. 12

My Record of Personal Affairs:



               _____________________________________________________________________
               First                           Middle                       Last

               _____________________________________________________________________
               Re�red  Military Grade         Branch of Service             SSN

               _____________________________________________________________________
               Street Address                City/State                     Zip Code

               _____________________________________________________________________
               Service Number                Date of Entry and Date, Type, and Character of separa�on from military

               Date and Place of Birth:



               _____________________________________________________________________
               City, State, Zip                                             Month/Day/Year

               Parents’ Information:


               Father ________________________________________________________________
                        First                  Middle                 Last

               Mother________________________________________________________________
                        First                  Middle                 Last


               Children:


               _____________________________________________________________________
                First            Middle            Last                     DOB               SSN

               _____________________________________________________________________
                First            Middle            Last                     DOB               SSN

               _____________________________________________________________________
                First            Middle            Last                     DOB               SSN

               _____________________________________________________________________
                First            Middle            Last                     DOB               SSN













            10  Planning Your Legacy:  VA Survivors and Burial Benefits Kit
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