Va Form 26-1880 - 2008 Request For A Certificate Of Eligibility
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2Citywide Home Loans, NMLS# 67180 | Originator: Mike Molina, NMLS# 230545
OMB Control No. 2900-0086
Respondent Burden: 15 minutes
Department of Veterans Affairs
Department of Veterans Affairs
Eligibility Center
TO
REQUEST FOR A CERTIFICATE OF
P. O. Box 20729
ELIGIBILITY
Winston-Salem, NC 27120
NOTE: Please read information on reverse before completing this form. If additional space is required, attach a separate sheet.
1. FIRST-MIDDLE-LAST NAME OF VETERAN
2. DATE OF BIRTH
3. VETERAN'S DAYTIME TELEPHONE NO.
4A. ADDRESS OF VETERAN
(No., street or rural route, city or P.O. State and ZIP Code)
5. MAIL CERTIFICATE OF ELIGIBILITY TO:
(Complete ONLY if the Certificate
is to be mailed to an address different from the one listed in Item 4A)
4B. E-MAIL ADDRESS OF VETERAN
(If applicable)
6. MILITARY SERVICE DATA (ATTACH PROOF OF SERVICE - SEE PARAGRAPH "D'' ON REVERSE)
B. PERIODS OF ACTIVE SERVICE
E. SERVICE No.
A.
C. NAME
(Show your name exactly as it appears
D. SOCIAL SECURITY
F. BRANCH OF
(If different from
ITEM
NUMBER
SERVICE
on your separation papers or Statement of Service
DATE FROM
DATE TO
Social Security No.)
1.
2.
3.
4.
7A. WERE YOU DISCHARGED, RETIRED OR SEPARATED FROM SERVICE BECAUSE OF DISABILITY
7B. VA CLAIM FILE NUMBER
OR DO YOU NOW HAVE ANY SERVICE-CONNECTED DISABILITIES?
C -
YES
NO
(If ''Yes,'' complete Item 7B)
8. PREVIOUS VA LOANS ( Must answer N/A if no previous VA home loan. DO NOT LEAVE BLANK )
E. DO YOU
F. DATE PROPERTY
B. TYPE
D. DATE
G. VA LOAN
(Submit
STILL OWN
WAS SOLD
A.
(Home, Refinance,
C. ADDRESS OF PROPERTY
OF
NUMBER
a copy of HUD-1,
THE
ITEM
Manufactured Home,
LOAN
(If known)
Settlement Statement,
PROPERTY?
or Direct)
(YES/NO)
if available)
1.
2.
3.
4.
5.
6.
I CERTIFY THAT
the statements herein are true to the best of my knowledge and belief.
9. SIGNATURE OF VETERAN
10. DATE SIGNED
(Do NOT print)
FEDERAL STATUTES PROVIDE SEVERE PENALTIES FOR FRAUD, INTENTIONAL MISREPRESENTATION, CRIMINAL CONNIVANCE OR
CONSPIRACY PURPOSED TO INFLUENCE THE ISSUANCE OF ANY GUARANTY OR INSURANCE BY THE SECRETARY OF VETERANS AFFAIRS.
FOR VA USE ONLY
11A. DATE CERTIFICATE ISSUED
11B. SIGNATURE OF VA AGENT
VA FORM
26-1880
EXISTING STOCKS OF VA FORM 26-1880, JAN 2006
Calyx Form - Vaelig.frm (08/09)
APR 2008
WILL BE USED.
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