Va Form 29-541 - Certificate Showing Residence And Heirs Of Deceased Veteran Or Beneficiary
Download a blank fillable Va Form 29-541 - Certificate Showing Residence And Heirs Of Deceased Veteran Or Beneficiary in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form 29-541 - Certificate Showing Residence And Heirs Of Deceased Veteran Or Beneficiary with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB Control No. 2900-0469
Respondent Burden: 30 minutes
1. INSURANCE FILE NUMBER
CERTIFICATE SHOWING RESIDENCE AND HEIRS
2. NAME OF INSURED
(First, Middle, Last)
OF DECEASED VETERAN OR BENEFICIARY
PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of
1974 or Title 38, Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S.
Government Life Insurance Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain this benefit.
RESPONDENT BURDEN: We need this information to determine your eligibility for a death benefit. Title 38, United States Code, allows us to ask for this information.
We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed.
Valid OMB control numbers can be located on the OMB Internet page at If desired, you can call
1-800-827-1000 to get information on where to send comments or suggestions about this form.
3. THE QUESTIONS REFER TO THE ESTATE OF:
4A. ARE THERE HEIRS TO THIS ESTATE?
(Give first, middle, last name)
YES
NO
4B. HAS THERE BEEN OR WILL THERE BE A COURT-APPOINTED EXECUTOR OR
ADMINISTRATOR APPOINTED FOR THIS ESTATE?
YES
(If "Yes," see note below. If "No," complete remaining items)
NO
NOTE: If there has been or will be an executor or administrator appointed, furnish letters testamentary or letters of administration. Skip
the remaining items, sign on reverse, and return this form with your letters.
5. STATE OF RESIDENCE AT TIME OF DEATH (EXCLUDING MILITARY SERVICE)
IMPORTANT: Items 6 through 9 - Write the word "NONE" in each item where there is no next of kin. If any information is unknown
to the witnesses, the words "DO NOT KNOW" should be written in the space provided. If additional space is required, attach a
separate sheet. If separate sheets are necessary, each sheet must be signed.
6. SPOUSE OF DECEASED VETERAN/BENEFICIARY
A. NAME OF SPOUSE
B. AGE
C. ADDRESS
D. DATE OF DEATH
E. YEAR OF MARRIAGE
(If deceased)
7. CHILD(REN) OF DECEASED VETERAN/BENEFICIARY
A. NAME(S) OF CHILD(REN)
D. DATE OF
E. PARENTS OF
B. AGE
C. ADDRESS
DEATH
(Include illegitimate, adopted
CHILD(REN)
and unborn child(ren))
(If deceased)
8. PARENTS OF DECEASED VETERAN/BENEFICIARY
C. ADDRESS
A. NAME OF PARENT
B. AGE
D. DATE OF DEATH (If deceased)
FATHER
MOTHER
IMPORTANT: If spouse, child(ren), or parent(s) survive the insured, skip to Item 11A on the reverse.
29-541
VA FORM
EXISTING STOCKS OF VA FORM 29-541, FEB 2005,
(Continued on Reverse)
SEP 2006
WILL BE USED.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal