Va Form 21-526 - Part D - Veterans Application For Compensation And/or Pension (Page 3 of 4) in pdf

Va Form 21-526 - Part D - Veterans Application For Compensation And/or Pension Page 3

Tell us about your net worth and your dependents’ net worth.

SECTION

For items 7a-h: provide the amounts. If

(Continued)

none, write "0" or "None"

Child(ren)

III. Name:

I. Name:

II. Name:

Source

Veteran

Spouse

(first, middle initial, last)

7a. Cash, non-interest

bearing bank

accounts

7b. Interest bearing bank

accounts,certificates

of deposit (CDs)

7c. IRAs, Keogh Plans,

etc.

7d. Stocks and bonds

7e. Mutual funds

7f. Value of business

assets

7g. Real property

(not your home)

7h. All other property

Tell us

SECTION

about the

In this section, we ask you to give us specific information about the income you have

income

received and the income you expect to receive from all sources. You will need to enter this

you have

information in the tables on Page 4. In these tables,

received

and you

Report the total amounts before you take out deductions for taxes, insurance, etc.

expect to

Do not report the same information in both tables.

If you expect to receive a payment, but you don’t know how much it will be, write

receive

"Unknown" in the space.

If you do not receive any payments from one of the sources that we list, write "0" or

"None" in the space.

If you are receiving monthly benefits, give us a copy of your most recent award letter.

This will help us determine the amount of benefits you should be paid.

Payments from any

source will be

8. Will you receive any

9. Will you receive

10. Do you expect to receive

counted, unless the

income from rental

any income from

money from a civilian agency,

law says that they

don’t need to be

property or from operation

the operation of a

corporation, or individual, because

counted. VA will

determine any amount

of a business within 12

farm within 12

of personal injury or death within 12

that does

months of the day you sign

months of the day

months of the day you sign this

not count.

this form?

you sign this form?

form?

Yes

21-526, Part D

Page 3

Va Form 21-526 - Part D - Veterans Application For Compensation And/or Pension Page 3

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