Dd Form 137-6, Dependency Statement - Full Time Student 21 - 22 Years Of Age Page 2

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5. STUDENT'S OTHER PARENT(S)

(1) NAME (Last, First, Middle Initial)

(2) RELATIONSHIP TO STUDENT

(3) COMPLETE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

c. IS/ARE OTHER PARENT(S) IN ANY BRANCH OF SERVICE, INCLUDING RESERVE OR NATIONAL GUARD (X one)

YES

(If Yes, show rank, name, SSN, and military address.)

d. DOES OTHER PARENT CLAIM STUDENT FOR BASIC ALLOWANCE FOR HOUSING (BAH), TRAVEL ALLOWANCE, OR USIP CARD (X one)

YES

(If Yes, explain.)

6. STUDENT'S RESIDENCE

a. ADDRESS WHERE STUDENT RESIDES WHILE ATTENDING SCHOOL (Street, Apartment Number, City, State, ZIP Code)

b. TYPE OF RESIDENCE (X and complete as applicable)

STUDENT'S OWN HOME OR APARTMENT

HOME OR APARTMENT OF OTHER PARENT

HOME OR APARTMENT OF MEMBER

HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)

HOME OR APARTMENT OF MEMBER'S FORMER SPOUSE

HOME OR APARTMENT OF MEMBER'S WIDOW OR WIDOWER

OTHER (Explain)

STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY

c. ADDRESS WHERE STUDENT RESIDES, IN EXCESS OF 90 DAYS, WHILE NOT ATTENDING SCHOOL (Street, Apartment Number, City, State, ZIP Code)

d. TYPE OF RESIDENCE (X and complete as applicable)

STUDENT'S OWN HOME OR APARTMENT

HOME OR APARTMENT OF OTHER PARENT

HOME OR APARTMENT OF MEMBER

HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)

HOME OR APARTMENT OF MEMBER'S FORMER SPOUSE

HOME OR APARTMENT OF MEMBER'S WIDOW OR WIDOWER

OTHER (Explain)

STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY

7. PERSONS LIVING IN HOUSEHOLD WITH STUDENT

List all persons who live in the household, including claimed student. If employed, show hours per week worked. Continue in Remarks if more

space is needed.

d. MARRIED (X)

e. EMPLOYED

b. RELATIONSHIP

a. NAME (Last, First, Middle Initial)

c. AGE

TO STUDENT

YES

HOURS PER WEEK

NO (X)

8. HOUSEHOLD EXPENSES

List the household expenses for all persons living in the home. If expense was one-time only, such as purchase of a new chair, do not show this as

a monthly expense; list it as an expense for the past 12 months. If student resides in the member's household or in a dwelling owned by the member,

use Fair Rental Value (FRV) for dwelling. If student does not reside in member's household or in a dwelling owned by member, list actual mortgage,

rent, or FRV if dwelling is mortgage-free. If FRV is used, give a brief explanation of how Fair Rental Value was obtained using the Remarks section.

FAIR RENTAL VALUE (FRV): FRV is a single monthly sum for the entire dwelling where the student lives. This sum is an amount the owner can

reasonably expect to receive from a stranger to rent the dwelling. FRV will not include food, utilities, furniture, and home repairs, which are listed

separately.

(1)

(2)

(1)

(2)

PRESENT MONTHLY

TOTAL EXPENSE FOR

PRESENT MONTHLY

TOTAL EXPENSE FOR

ITEM

EXPENSE

PAST 12 MONTHS