Fillable VBA-29-541-ARE VA Form 29-541

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VBA-29-541-ARE VA Form 29-541

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The VBA-29-541-ARE VA Form 29-541 form is 2 pages long and contains:

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  • 85 other fields

Country of origin: US
File type: PDF

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OMB Control No. 2900-0469
Respondent Burden: 30 Minutes
Expiration Date: 05/31/2021
VA FORM
MAY 2018
D. DATE OF DEATH (If deceased)
E. YEAR OF MARRIAGE
D. DATE OF DEATH
(If deceased)
A. NAME OF SPOUSE B. AGE C. ADDRESS
4A. ARE THERE HEIRS TO THIS ESTATE?
5. STATE OF RESIDENCE AT TIME OF DEATH (EXCLUDING MILITARY SERVICE)
PARENT(S)
PARENT(S)
A. NAME OF PARENT B. AGE
E. PARENTS OF
CHILD(REN)
C. ADDRESSB. AGE
D. DATE OF
DEATH
(If deceased)
A. NAME(S) OF CHILD(REN)
(Include illegitimate, adopted
and unborn child(ren))
6. SPOUSE OF DECEASED VETERAN/BENEFICIARY
7. CHILD(REN) OF DECEASED VETERAN/BENEFICIARY
8. PARENTS OF DECEASED VETERAN/BENEFICIARY
1. INSURANCE FILE NUMBER
2. NAME OF INSURED
(First, Middle, Last)
3. THE QUESTIONS REFER TO THE ESTATE OF:
(Give first, middle, last name)
CERTIFICATE SHOWING RESIDENCE AND HEIRS OF
DECEASED VETERAN OR BENEFICIARY
29-541
SUPERSEDES VA FORM 29-541, JUN 2014,
WHICH WILL NOT BE USED.
(If "Yes," see note below. If "No," complete remaining items)
NOTE: If there has been or will be an executor or administrator appointed, furnish letters testamentary or letters of administration. Skip the
remaining items, sign on reverse, and return this form with your letters.
IMPORTANT: Items 6 through 9 - Write the word "NONE" in each item where there is no next of kin. If any information is unknown to the
witnesses, the words "DO NOT KNOW" should be written in the space provided. If additional space is required, attach a separate sheet. If separate
sheets are necessary, each sheet must be signed.
IMPORTANT: If spouse, child(ren), or parent(s) survive the insured, skip to Item 11A on the reverse.
(Continued on Reverse)
C. ADDRESS
YES NO
NO
YES
PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act
of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA29, Veterans and Uniformed Services Personnel
Programs of U.S. Government Life Insurance - VA, and published in the Federal Register. Your obligation to respond is required to obtain this benefit.
RESPONDENT BURDEN: We need this information to determine your eligibility for a death benefit. Title 38, United States Code, allows us to ask for this
information. We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or
sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not
displayed. Valid OMB control numbers can be located on the OMB Internet page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call
1-800-827-1000 to get information on where to send comments or suggestions about this form.
4B. HAS THERE BEEN OR WILL THERE BE A COURT-APPOINTED EXECUTOR OR
ADMINISTRATOR APPOINTED FOR THIS ESTATE?
D. DATE OF DEATH (If deceased)
A. NAME(S) OF BROTHER(S) AND
SISTER(S)
B. AGE C. ADDRESS
9. BROTHER(S) AND SISTER(S) OF DECEASED VETERAN/BENEFICIARY
(STATE WHETHER FULL, HALF-BLOOD, OR ADOPTED)
10. FIRST WITNESS INFORMATION 11. SECOND WITNESS INFORMATION
A. FIRST, MIDDLE, LAST NAME
B. DAYTIME TELEPHONE NUMBER
(Include Area Code)
C. RELATIONSHIP TO DECEASED
A. FIRST, MIDDLE, LAST NAME
B. DAYTIME TELEPHONE NUMBER
(Include Area Code)
D. SIGNATURE (Sign in ink)
C. RELATIONSHIP TO DECEASED
D. SIGNATURE
(Sign in ink)
WE CERTIFY THAT to the best of our knowledge and belief, the above named are the only relatives of the veteran/beneficiary,
living or dead, and that the foregoing statements are true.
PENALTY: The statements contained herein are made with the full knowledge of the penalties imposed by law for making false statements of a material fact.
VA FORM 29-541, MAY 2018
IMPORTANT: If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you
and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you
become eligible for benefits) (38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is available at
http://www.va.gov/opa/marriage/.
NAME(S) OF CHILD(REN)
OF DECEASED BROTHER(S)
AND SISTER(S)
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VBA-29-541-ARE VA Form 29-541

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Completed 6 June 2020

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