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Click ‘Get Form’ to open VA Form 21-4170 in our editor.
Begin by filling out Section I, which requires information about the veteran and the spouse or surviving spouse. Enter names, social security numbers, and addresses clearly.
Proceed to Section II to provide details about your claimed marital relationship. Include dates and places where you began living together as husband and wife.
In Section III, indicate whether you have children together. If yes, list their full names and places of birth.
Complete Section IV by detailing all marriages of both the veteran and the spouse or surviving spouse. Attach any necessary documents like divorce decrees if applicable.
Finally, sign in Section V to certify that all information is true. Ensure witnesses sign if required.
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Information to VA. 21-4170. Statement of Marital Relationship. 10/04. 21-4171. Supporting Statement Regarding Marriage. 11/04. 21-4176. Report of AccidentalRead more
VA Form 21-4170 - Veterans Benefits Administration
Use this form to provide information to VA to determine your marital status. For more information, contact VA online through Ask VA: , or callRead more
Jul 1, 1996 The information in this document has been funded wholly or in part by the United States Environmental. Protection Agency under Contract No.Read more
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