Get Irs Form 2065

ADDRESS Street City State and ZIP Code d. TELEPHONE Include Area Code e. DATE SIGNED f. SIGNATURE OF SPONSOR DD FORM 2065 OCT 2003 PREVIOUS EDITION IS OBSOLETE.. OMB No* 0704-0030 OMB approval expires May 31 2006 DISPOSITION OF REMAINS - REIMBURSABLE BASIS The public reporting burden for this collection of information is estimated to average 20 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information* Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing the burden to the Department of Defense Executive Services Directorate 0704-0030. Respondents should be aware that notwithstanding any other provision of law no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION* RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 1. PRIVACY ACT STATEMENT AUTHORITY 10 USC Sections 1481 through 1488 EO 9397. PRINCIPAL PURPOSE To record the sponsor s disposition instructions for the remains. To record cost for necessary services and supplies. To record the name address and telephone number of a person in CONUS who may be contacted concerning the remains if necessary. ROUTINE USES None. DISCLOSURE Voluntary however failure to furnish the requested information may delay processing and shipment of remains to final destination* 1. TO Recipients and address authorized distribution 2. NAME OF DECEASED Last First Middle Initial 3. RELATIONSHIP TO SPONSOR 4. NAME OF SPONSOR Individual Agency or Firm 6. GRADE OF SPONSOR 5. ADDRESS OF SPONSOR Street City State and ZIP Code 7. SSN OF SPONSOR I THE UNDERSIGNED DESIRE THAT DISPOSITION OF REMAINS BE EFFECTED AS INDICATED BELOW X applicable option 8. OPTION 1 a* Preparation of remains at the Government mortuary and return of remains to a continental United States port of entry in a transfer case. The port mortuary will furnish the requested services and supplies at a cost of. I have reimbursed the Government in this amount. It is requested that the remains be shipped to the following funeral home c* ADDRESS OF FUNERAL HOME Street City State and ZIP Code b. NAME OF FUNERAL HOME 9. OPTION 2 10. OPTION 3 - ARRANGEMENTS DESIRED Other than those described in Options 1 or 2 11. RELATIVE OF DECEASED or other person IN CONUS WHO MAY BE CONTACTED IF NECESSARY a* NAME Last First Middle Initial b. OMB No* 0704-0030 OMB approval expires May 31 2006 DISPOSITION OF REMAINS - REIMBURSABLE BASIS The public reporting burden for this collection of information is estimated to average 20 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information* Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing the burden to the Department of Defense Executive Services Directorate 0704-0030. Respondents should be aware that notwithstanding any other provision of law no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.