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Get VA 22-5495 2012

ON AVAILABLE - You may complete and submit your application online at www.gibill.va.gov PART I - APPLICANT INFORMATION 1. NAME (First, Middle Initial, Last) VA DATE STAMP (For VA Use Only) 2. SOCIAL SECURITY NUMBER 3. VA FILE NUMBER 4. SEX OF APPLICANT 5. DATE OF BIRTH MALE FEMALE 6. CURRENT MAILING ADDRESS (Number and street or rural route, city or P.O., State and 9 DIGIT ZIP Code) 7. TELEPHONE NUMBER(S) (Including Area Code) PRIMARY SECONDARY 8. E-MAIL ADDRESS (if applicable) 9. D.

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