If you selected Other, please specify
Please answer to the best of your ability:
By NYS Law, we cannot use PO Box as address, please enter physical address, use house number, mailbox number or
911 fire number. If you are not sure, we will review with you. Please complete to best of your ability.
(city, town, village)
MUST follow xxx-xx-xxxx
If you selected Other on etheir of the previous two selections, please specify
Even if retired, NYS Law requires this information. If disabled, please enter disabled, if unknown, please enter
unknown, if homemaker, please enter homemaker, if self employed, please enter type of self employment. We also
understand a person may have had several occupations, but NYS law allows only one entry.
If you are not sure, please enter “unsure” we will review with you.
Example - carpenter, teacher, administrator
Example - construction, education, technology
Example - Carpenters Local #123, Kingston Consolidated Schools, IBM Kingston
By NYS state law we are required to gather this information - Please note, if wife is surviving, provide maiden
If you do not have this information, please insert 'Unknown'
List 1st name, Last name. - If wife, list First name then Maiden name.
If not or never married or if you do not have this information insert 'Unknown'
It is very important that we have as accurate information as possible. A veteran is entitled to many benefits,
with out the proper documents, we will not be able to help you file for those benefits. If you don’t know,
please enter unsure.
We will do everything possible to make sure the veteran receives all the benefits they have earned by serving
If you selected unsure, please specify
If not, we may be able to help you obtain a copy
Year range - Example: 1950 - 1955