VERIFICATION OF GOVERNMENT/EMPLOYER PROVIDED QUARTERS ASSIGNED
1. Letter from housing office if assigned to active duty spouse, or
2. Certification letter from school.
DD FORM 2754 (BACK), SEP 2007
15. IF CLAIMING DEPENDENT CHILD(REN)
a. WHO HAS CUSTODY OF CHILD(REN)?
b. IF IN CUSTODY OF FORMER SPOUSE, AND FORMER SPOUSE IS ACTIVE DUTY OR INSTRUCTOR:
(2) DUTY LOCATION
c. DATE OF BIRTH OF YOUNGEST CHILD
CLAIMED AS A DEPENDENT (YYYYMMDD)
d. IF YOU DO NOT HAVE CUSTODY, DO YOU PAY CHILD SUPPORT?
IF "YES", INDICATE MONTHLY AMOUNT PAID
SUPPORTING DOCUMENTATION REQUIRED FOR ORIGINAL CERTIFICATION OF BAH
CERTIFICATION OF DEPENDENT(S)
1. Spouse - copy of marriage certificate with seal.
2. Child(ren) - copy of birth certificate with seal.
3. Child(ren) not in instructor's custody - divorce decree, legal separation agreement, court order.
1. Parent(s) or parent(s)-in-law - court order of guardianship.
2. Ward - Court order of guardianship.
3. Student (age 21 - 22 in school) - letter from learning instutution verifying full time enrollment.
4. Handicapped child over age 21 - medical sufficiency statement.
SECTION I - OHA (Applies to Overseas Locations Only)
16. ACCOMPANIED (X one)
17a. SHARER (X one)
b. IF YES, NUMBER OF SHARERS
18a. RENTER STATUS (X one)
b. IF RENTING, PROVIDE RENTAL/LEASE DATES:
(1) FROM (YYYYMMDD)
19a. MONTHLY RENT/MORTGAGE PAYMENT b. TAXES/INSURANCE AMOUNT (If not included in monthly mortgage
c. CURRENCY TYPE
20a. UTILITIES INCLUDED IN MONTHLY
RENT (X one)
b. IF "NO", LIST MONTHLY AMOUNT(S) BELOW:
(2) TRASH REMOVAL (3) ELECTRIC (4) GAS
21. DUTY LOCATION (City and Country)
SUPPORTING DOCUMENTATION REQUIRED FOR OHA (Original Certification and Recertification)
1. Copy of rental lease, or proof of mortgage payment amount (copy of payment coupon).
2. Evidence of real estate taxes, and homeowner insurance costs, if not included in mortgage payment if renter status in 18.a. is marked "Own".
SECTION II - COLA (Applies to Overseas Locations, Alaska and Hawaii Only)
22. NUMBER OF DEPENDENTS RESIDING
23. JTR LOCATION (To be filled out by pay technician)
I certify that the information provided is true and correct. Entitlements will not be included in the applicable pay computation without this verification
and certification of eligibility.
SIGNATURE OF INSTRUCTOR DATE SIGNED
14. DEPENDENT RELATIONSHIP (Enter one of the following codes)
NOTE: If code selected is B, complete all of Item 15. If code C, K. S, T, or W, complete 15c. only. If code A, D, I, L, or R, do not complete Item
I - Instructor married to
R - Own right (single)
WITH DEPENDENT OTHER THAN CHILD(REN)
A - Spouse
D - Parent (including "In Loco Parentis"
which is a person who stood in place
of the natural parents)
L - Parent(s)-in-law
WITH DEPENDENT CHILD(REN)
B - Child in legal custody of
someone other than instructor
C - Child in instructor's custody
K - Ward
S - Student (age 21 - 22)
T - Handicapped child
(over age 21)
W - Instructor married
to instructor with
(2) TO (YYYYMMDD)