Eastern Essex District Department of Veterans Services - Helpful To Us If You Could Update Your Contact Information

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Helpful To Us If You Could Update Your Contact Information


	We maintain a file on all veterans and widows in our area of responsibility so that we can contact you when issues we believe of benefit to you arise. To insure we maximize benefit to you, please fill in the information as completely as possible, and update the information when it changes.

Please provide the following information:

Would you like to receive periodic news releases (we post on this site) sent directly to your email

Yes
No

Please tell us if you are:

A Veteran
The Widow of a Veteran
An Interested Friend of Veterans

If you are the widow of a Veteran or an interested friend, please tell us your name or the name of your organization

Please indicate the Veteran's branch of service.

If you selected "Other Branch", please describe.

What are your periods of active service?

Do you have a copy of your discharge (DD214)?

Yes
No

Do I have a copy of your discharge (dd214) on file in my office?

Yes
No

Are you receiving compensation or a pension from the VA?

Yes
No

If YES, please provde your VA C# or tell us if it is a CSS

Do you have a claimant's representative with the VA? IF NO, leave blank. If YES, indicate which organization.

Pleae indicate if any of these apply

% Service connected Disability
DIC if Widow (er)
Pension Only

If you are the veteran, are you enrolled in and using the VA Healthcare System?

Yes
No

If NO, are you interested in using the VA Healthcare System?

Yes
No

Would you like us to contact you when the need for volunteers in my Veterans office arises?

Yes
No