Get PA form MV-145A 2013
FICE ADMINISTRATOR OR HIS/HER DESIGNATED REPRESENTATIVE (Philadelphia or Pittsburgh) OR SERVICE UNIT IN WHICH THE VETERAN SERVED. This is to certify that the veteran listed above with VA number ______________________ has service connected disabilities rated at 100% or has the following service connected disability listed on the reverse side of this application under “Eligibility Requirements”: ______________ . NOTE: If reason code #4 is listed, please indicate the type of device used: _____.
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