Va Form 26-1880 (2006) - Request For A Certificate Of Eligibility
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1OMB Approved 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
Winston-Salem, NC 27120
ELIGIBILITY
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.
4. ADDRESS OF VETERAN
(No., street or rural route, city or P.O. State
5. MAIL CERTIFICATE OF ELIGIBILITY TO:
(Complete ONLY if the Certificate is to be
and ZIP Code)
mailed to an address different from the one listed in Item 4)
Texas One Mtg., 10988 E Crystal Falls Pkwy.
Leander, TX 78641-2248
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
on your separation papers or Statement of Service
NUMBER
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
STILL OWN
WAS SOLD
(Submit
A.
(Home, Refinance,
C. ADDRESS OF PROPERTY
OF
NUMBER
THE
a copy of HUD-1,
ITEM
Manufactured Home,
LOAN
(If known)
PROPERTY?
Settlement Statement,
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
(Do NOT print)
10. DATE SIGNED
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
11 A. DATE CERTIFICATE ISSUED
11 B. SIGNATURE OF VA AGENT
VA FORM
SUPERSEDES VA FORM 26-1880, JAN 2005,
Calyx Form - Vaelig.frm (06/06)
26-1880
JAN 2006
WHICH WILL NOT BE USED.
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