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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
