Get Form 812 0705

Filling out the Form 812 0705 online can seem daunting, but this guide will help you through the process. By following these steps, you can ensure that your application for admission to a Missouri Veterans Home is completed accurately and efficiently.

Follow the steps to complete the Form 812 0705 online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by filling out the general information section. Provide your full name, social security number, and present mailing address, including the street and number, city, state, and zip code.
3. Input your date of birth, telephone number, and email address. Indicate your gender and marital status, as well as your place of birth.
4. If applicable, enter your spouse's name, date of birth, and address. You may also need to provide your spouse's social security number and place of marriage.
5. Answer the question regarding physical residency in Missouri for the past 180 days, and provide your service-connected disability rating if it is relevant.
6. Fill out your insurance information, including whether you have Medicare and details about any other insurance policies you hold.
7. Provide medical information, including any hospitalizations or nursing home residencies within the past year, noting the admitting and discharge dates as necessary.
8. Complete the emergency information section by listing two contacts to be notified in case of an emergency.
9. Fill out the burial information section, which requires the name and address of the chosen undertaker and desired burial location.
10. Review the signature section. Ensure that the applicant or their legal representative signs the form, and include the date. If the signature is provided by an 'x,' a witness must be present.
11. If notary information is required, ensure that the form is notarized properly. Include the notary's signature and seal.
12. Finally, you can save your changes, download the completed form, print it for hard copies, or share it as required.

Complete your Form 812 0705 online today to ensure your application is processed promptly.