Fillable Massachusetts Veterans Bonus Program - Deceased Veteran Bonus Application

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Massachusetts Veterans Bonus Program - Deceased Veteran Bonus Application

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The Massachusetts Veterans Bonus Program - Deceased Veteran Bonus Application form is 4 pages long and contains:

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  • 33 check-boxes
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Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Applicant’s Information (Individual applying on behalf of the deceased veteran)
First Name:
Middle
Initial:
Last Name:
Email:
Date of Birth:
Relationship to Veteran:
SSN:
Gender:
Male Female
Street Address:
Apt:
City:
State:
Zip Code:
Veteran’s Information
First Name:
Middle
Initial:
Last Name:
SSN:
Veteran’s name when entered the service (if different than current name – Name Change Documentation Required)
First Name:
Middle
Initial:
Last Name:
Gender:
Male Female
Veteran’s address at Time of Entry into Service or Activation for Reserve and National Guard personnel
Street Address:
Apt:
City:
State:
Zip Code:
Veteran’s Service Information
Date of Entry:
Discharge Date:
(If applicable)
Branch of Service:
Grade:
Character of Service:
Date of Activation:
(Reserve/Guard)
Date Activation Ended:
(Reserve/Guard)
Active Duty:
Reserve:
National Guard:
Bonus Information (check Bonuses applying for)
World War II:(16 Sep 40 – 25 Jul 47)
Died on Active Service:
One day to six months active
service:
Six months or more active
service:
Foreign service or merchant
marine:
Korean War:(25 Jun 50 – 31 Jan 55)
Died on Active Service:
90 days to six months stateside
active service:
Six months or more stateside active
service:
One day or more
overseas service:
Vietnam Conflict:(1 Jul 58 – 17 May 75)
Died on Active Service:
Six months or more active service other than Vietnam:
Service in Vietnam:
September 11, 2001 to Present:
Died on active service:
Six months
active service:
Subsequent six
months deployment:
Imminent Danger location:
Sub Imminent Danger:
Duty/Deployment History
Include all duty and deployment information that occurred after September 11, 2001. Documentation must be provided
Date Arrived
Date Departed
Base/Ship
Country/Body of water
Name of Operation
Signature
How did you hear about the program?
I hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate
Signature of Applicant:
Date:
Massachusetts Deceased Veterans' Bonus
1
Massachusetts Veterans Bonus Program
Office of the State Treasurer
One Ashburton Place, Room 1207
Boston MA 02108
(617)367-9333 Ext 859
Veteransbonus@tre.state.ma.us
Deceased Veteran Bonus Application
Other Family members’ information (Required if applicant is not the spouse of the deceased veteran). Relationship documentation must be provided.
Bonuses shall be paid to the decedent's heirs-at-law; provided, that if there is more than one heir-at-law, payments shall, in either case, be made in such
proportions as the state treasurer shall determine, and in determining the order of precedence, so far as practicable, the following order shall be observed:
spouse and children, mother or father, brother or sister, other dependents.
DOB
Name
Address
Phone
Spouse
Children
Parents
Father
Mother
Siblings
Other Dependents
I hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate
Signature
Date
Massachusetts Deceased Veterans' Bonus
2
Massachusetts Veterans Bonus Program
Office of the State Treasurer
One Ashburton Place, Room 1207
Boston MA 02108
(617)367-9333 Ext 859
Veteransbonus@tre.state.ma.us
Deceased Veteran Bonus Application
Applicant’s Information (To be completed by applicant)
Bring a copy of your DD214 for the City/Town clerk to verify entry/activation date
Name when entered the Armed Forces or for Reserve/Guard when activated
First Name:
Middle
Initial:
Last Name:
Current Name if different than above
First Name:
Middle
Initial:
Last Name:
Name of parent or legal Guardian if you were 18 or younger when entered the Armed Forces or Activated
First Name:
Middle
Initial:
Last Name:
Address at time entered the Armed Forces or Activated (Reserve/Guard)
Street Address:
Town/City:
State:
Zip Code:
Date Entered Armed Forces or Date(s) Activated (Reserve/Guard):
(DD214 Block 12A or Block 14)
City/Town Clerk Instructions: The above individual is applying for the Massachusetts Veterans’ Bonus. The laws for each bonus require that
the member must have lived in Massachusetts at least 6 months immediately prior to entering or being activated for the Reserve or National Guard
in the Armed Forces. Please verify with your city/town records that the member lived in Massachusetts for at least 6 months prior to entering the
Armed Forces or being activated if Reserve/Guard.
Certifying Official’s Information (To be completed by City/Town Official)
I hereby certify that, according to the official records of this
office the above individual or legal guardian if minor at the
time resided at:
Street Address & City/Town:
Resided at the above address on the date listed. At least six
months immediately prior to entering the Armed Forces or
being activate for Reserve/Guard personnel
As listed on the member’s DD214 Block 12A, Block 14 (Older
DD214s) or other documentation provided by the applicant
Date:
_______________________ _____________
Month Year
If entered January – June previous year is required
If entered July – December current year is required
Certifying Official’s Name:
Phone Number:
Title:
Name of City or Town:
City/Town Clerk’s Signature: __________________________ Date: _______________
Stamp Town/City seal in this area
Massachusetts Deceased Veterans' Bonus
3
Massachusetts Veterans Bonus Program
Office of the State Treasurer
One Ashburton Place, Room 1207
Boston MA 02108
(617)367-9333 Ext 859
Veteransbonus@tre.state.ma.us
Certificate of Massachusetts Residency Form
Da
te entered Armed Forces
Reserve/Guard activation date
The Office of the State Treasurer administers a Veterans Bonus for the below wars. Use this checklist to
help you fill out the application form and provide a complete set of supporting documentation to prove
your eligibility for the deceased veteran’s bonus from Massachusetts.
• If the veteran died while on active service, family members are eligible for the maximum amount available
for that service period.
• If the veteran died after their service and did not receive the bonus that they were qualified for, the
family members are eligible for their bonus.
• Eligible bonuses shall be paid to the decedent's heirs-at-law.
• If there is more than one heir-at-law, payments shall, in either case, be made in such proportions as the
state treasurer shall determine, and in determining the order of precedence, so far as practicable, the
following order shall be observed:
1. Spouse and children
2. Mother or Father
3. Brother or Sister
4. Other dependents
World War II
Korean
Vietnam
Global War on Terrorism
Service between
9/16/40 – 6/25/47
Service between
6/25/50 - 1/31/55
Service between
7/1/58 – 5/17/75
Service on or after
9/11/01 - present
Died on Active Service
$300
Died on Active Service
$300
Died on Active Service
$300
Died on Active Service
$1000
Documentation Required
Death Certificate or DD2064 (if died overseas on active service)
DD214 member 4 copy or DD1300 Casualty Report (if died while on active service)
If current spouse is not listed on death certificate, provide marriage certificate
If applicant is a child of deceased veteran – applicant’s birth certificate or other
documentation showing paternity
Relationship documentation for siblings
Application
Correct contact information for applicant
If veteran’s name is different than when entered the military, include name change document
Proof of Residency
Veteran’s Certificate of Residency signed by city/town clerk with the city/town seal, with the
correct residency year on Certificate of Residency
• Entered/activated in the months January – June: write the prior year
• Entered/activated in the months of July – December: write the current year
If using high school diploma, veteran must have entered military the same year graduated
If using other documents, must show name and address prior to entering the military
Mail the completed application and supporting documentation to the below address:
(It is recommended to keep a copy of your application package)
Office of the State Treasurer (Deceased Veteran Bonus)
One Ashburton Place, Room 1207
Boston MA 02108
Massachusetts Deceased Veterans' Bonus
4
Massachusetts Veterans Bonus Program
Office of the State Treasurer
One Ashburton Place, Room 1207
Boston MA 02108
(617)367-9333 Ext 859
Veteransbonus@tre.state.ma.us
Deceased Veteran Bonus Application
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Completed 8 May 2020

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