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VA Form 21-4170 Printable, Fillable in PDF – This form must be completed by the veteran (if he or she is still alive) as well as the person who is claiming to be the veteran’s spouse or surviving spouse (if applicable). Take note that for the purposes of this form, the individual claiming to be the veteran’s spouse or surviving spouse is referred to as “the veteran’s spouse.” If you don’t know the answer, type “unknown” in the appropriate field. Please include any documentation that demonstrates your marital status, such as proof that you are holding yourself out as married or that you are commonly acknowledged as such in the community in which you live or have formerly resided. For example, leasing agreements, joint bank statements, utility bills, tax returns, insurance forms, job records, and any other paperwork indicating the couple’s marital status are examples of acceptable documentation. Please be informed that you will not get your original papers back. We strongly advise you to send certified copies of your documents instead. If more space is required, utilize Section VI: Remarks to provide the item number to which the answers relate as well as any other pertinent information.
