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) NAME OF CHILD'S CUSTODIAN VA FILE NUMBER COMPLETE MAILING ADDRESS OF CHILD OR CUSTODIAN 3 VA REGIONAL OFFICE RETURN ADDRESS IMPORTANT: Please read the enclosed EVR Instructions (VA Form 21-0510) before completing this form. This form is used by children and custodians of children receiving Old Law or Section 306 Pension. If you have been receiving a fixed rate of pension since 1960, you receive Old Law Pension. If you have been receiving a fixed rate of pension since 1978, you receive Se.

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