Va Form 21-535 - Application For Dependency And Indemnity Compensation By Parent(S) Page 4
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10Note: Skip to Section IV if the veteran was receiving VA compensation or pension at the
SECTION
Tell us about
time of his/her death.
III
the veteran's
18b. Place
18c. Service Number
active duty
18a. Entered Active
Service (first period)
service
1. Enter complete information
mo day yr
for all periods of service. If
18e. Place
18f. Branch of
18g. Grade, Rank or
more space is needed use
18d. Left This Active
Service
Rating
Service
Item 44 "Remarks."
mo day yr
2. If the veteran never filed a
claim with VA, attach the
18i. Place
18j. Service Number
18h. Entered Active
original DD214 or a certified
Service (second period)
copy for each period of
service listed. We will return
mo day yr
original documents to you.
18l. Place
18m. Branch of
18n. Grade, Rank or
18k. Left This Active
Service
Rating
Service
mo day yr
SECTION
Definitions:
Tell us about
Parent means a biological mother or father, adoptive mother or father, and a foster mother or father.
IV
the veteran's
A foster parent is a person who stood in the relationship of a parent to a veteran for at least one year
parents
before the veteran's last entry into active service. The foster relationship must have begun prior to
the veteran's 21st birthday. If you are claiming benefits as the foster parent of the veteran, you will
Provide a copy of the veteran's
also need to complete VA Form 21-524, Statement of Person Claiming To Have Stood in Relation of
public record of birth or a copy
Parent. If you need a copy of this form, you may contact VA as shown on page 1, of the General
of the court record of adoption
Instructions or download the form from our website at Note: Only
if the veteran was adopted.
one father and one mother can be recognized for benefit payment purposes.
The age of majority is determined by State law and is age 18 in most States. Contact your State
government for more information.
Parental control is considered to have been given up if the parent has ceased to provide for the child
and the normal parent/child relationship has been broken.
19. What is the name of the veteran's mother? If deceased, provide date of death.
First
Middle
Last
mo day yr
20. What is the name of the veteran's father? If deceased, provide date of death.
First
Middle
Last
mo day yr
21. What is the name of the veteran's foster mother? (If none, write "none.") If deceased, provide
date of death.
First
Middle
Last
mo day yr
22. What is the name of the veteran's foster father? (If none, write "none.") If deceased, provide
date of death.
First
Middle
Last
mo day yr
21-535
page 2
VA FORM 21-535, FEB 2012
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