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Get VA 21-0781 2014-2022

REMARKS I certify that the foregoing statement(s) are true and correct to the best of my knowledge and belief. 10. SIGNATURE 11. DATE 12. TELEPHONE NUMBERS (Include Area Code) DAYTIME EVENING PENALTY - The law provides severe penalties which include fine or imprisonment or both, for the willful submission of any statement or evidence of a material fact, knowing it is false, or fraudulent acceptance of any payment to which you are not entitled. PRIVACY ACT NOTICE: The VA will not disclose inf.

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