Get VA 21-8416 2008
Or these expenses. I certify that the above information is true. 6A. DAYTIME TELEPHONE NO. (Include Area Code) 7A. SIGNATURE OF CLAIMANT (Do NOT print) 6B. EVENING TELEPHONE NO. (Include Area Code) 7B. DATE 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: VA will not d.
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