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Get VA 21-22 2000

RSE BEFORE COMPLETING THE FORM 1. LAST-FIRST-MIDDLE NAME OF VETERAN 2. VA FILE NUMBER (Include prefix) 3. NAME ONLY OF SERVICE ORGANIZATION RECOGNIZED BY THE DEPARTMENT OF VETERANS AFFAIRS (See list on reverse side before selecting organization) INSTRUCTIONS - TYPE OR PRINT ALL ENTRIES 4. SOCIAL SECURITY NUMBER 5. INSURANCE NUMBER(S) (Include letter prefix) 6A. SERVICE NUMBER(S) 6B. BRANCH OF SERVICE 7. NAME OF CLAIMANT (If other than veteran) 8. RELATIONSHIP (If other than veteran) 9. .

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