Monday, December 10, 2018

VA Related Forms

Lycoming County Veterans Affairs         
    
                                                                                               
                                                                                          Forms         

         
The following application forms can be filled out on-line and printed.

 NOTE:  Due to changes in legislation, the county benefits now available to the families of deceased veterans include the following:

  •  $75 burial benefit for:
    1. Deceased Veteran – both Wartime and Peacetime (including National Guard and Reserves) 
    2. Deceased Veteran’s Spouse
  •  $100 expense benefit toward the purchase of a private headstone or the installation of a military headstone for Deceased Veteran only

PLEASE USE THE FORMS BELOW TO REQUEST THESE BENEFITS:

 Please submit applications to:

George W. Heiges
Office of Veterans Affairs
County of Lycoming
48 West Fourth Street
Williamsport, PA 17701

 

Veteran’s Burial Benefit Application

Instructions

 

1.  A Deceased Service Person is defined as any person, at the time of death, serving in, or having served in and been honorably separated from the Army, Navy, Air Force, Marine Corps, Coast Guard, or any women’s organization officially connected therewith, (1) during any war or armed conflict in which the United States has been, is now or shall thereafter be engaged, or (2) in a zone where a campaign or state or condition of war or armed conflict (established by the record of the Department of Defense of the Federal Government) the existed. (Sec. 1908, “The County Code” of 1955, as amended.)

 

2.  Application must be made by the personal representative, if any, of the deceased service person, and if no such personal representative has qualified then by any next of kin, individual, or veterans’ organization, who or which assumes responsibility for the cost of burial of the body.  (Sec. 1911, “The County Code” of 1955, as amended.)

 

3.  Application must be made within one year from the date of death, except where the deceased service person died while in the service, when application may be made at any time thereafter.  No application will be given consideration unless fully completed.

 

4.  The following papers must be attached to this application:

(a)     Official death certificate, or if not procurable, either (1) an affidavit of one or more persons personally acquainted with the deceased and the fact of his or her death, or (2) proof of the record of death kept by the attending physician, or (3) the record burial kept by the undertaker by whom he was buried or (4) the record of the church, burial association or cemetery company maintaining the cemetery in which he was buried.

(b)     Honorable discharge or other official record showing was service or service in zone where campaign or state or condition of was existed.  Copies of War or Navy Department or Air Force records on file with State Department of Military Affairs will be accepted.

(c)     Proof of legal residence in this county, except in cases where such residence is not required.

 

 


Deceased Service Person’s Spouse Burial Benefit

Instructions

 

1.  A Deceased Service Person’s Spouse is defined as the unmarried widow or widower of any deceased service person, at the time of his/her death, serving in, or having served in and been honorably separated from the Army, Navy, Air Force, Marine Corps, Coast Guard,  (1) during any war or armed conflict in which the United States has been, is now or shall thereafter be engaged, or (2) in a zone where a campaign or state or condition of war or armed conflict (established by the record of the Department of Defense of the Federal Government) the existed. (Sec. 1908, “The County Code” of 1955, as amended.)

 

2.  Application must be made by the personal representative, if any, of the widow/widower, otherwise by any next of kin, individual, or veterans’ organization, who or which assumes responsibility for the cost of burial of the body.  (Sec. 1911, “The County Code” of 1955, as amended.)

 

3.  Application must be made within one year from the date of death.  No application will be given consideration unless fully completed.

 

4.  The following papers must be attached to this application:

(d)     Official death certificate of the deceased service person whose widow/widower the decedent is.

(e)     Official death certificate of the decedent, but if either or both death certificates are not procurable attach either (1) an affidavit of one or more persons personally acquainted with the deceased service person and/or the widow/widower, as the case may be, and the fact of his/her death, or (2) proof of the record of death kept by the attending physician, or (3) the record burial kept by the undertaker by whom he was buried or (4) the record of the church, burial association or cemetery company maintaining the cemetery in which he was buried.

(f)       Honorable discharge or other official record showing was service or service in zone where campaign or state or condition of was existed.  Copies of War or Navy Department or Air Force records on file with State Department of Military Affairs will be accepted.

(g)     Proof of legal residence of the widow/widower in this county.

(h)     Proof that decedent was married to the deceased service person at the time of his/her death and that she/he has not since remarried.

 

Penalty

Every person making a false oath is guilty of a felony and on conviction will be sentenced to pay a fine not exceeding $3000.00 or to undergo imprisonment be separate or solitary confinement, at labor not exceeding seven years or both and will be forever disqualified from being a witness in any matter in controversy.  (SEC. 322, Act of June 24, 1939, P L. 872.)

 

 

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Last Updated: 5/18/2017 9:21 AM
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