DD Form 137-7 "Dependency Statement - Ward of a Court"

What Is DD Form 137-7?

DD Form 137-7 or the Dependency Statement - Ward of a Court, is a form used for determining the relationship and dependency of claimed dependents and the member's entitlement to authorized benefits on behalf of a Ward of Court.

The latest version of the DD 137-7 - not to be confused with the DA 137 Form series - was released by the Department of Defense (DoD) in March 2018 with all previous editions being obsolete. An up-to-date fillable DD Form 137-3 is available for download below or can be found through the Executive Services Directorate website.

Disclosure of any personal information through the form is voluntary, but failure to file will result in a denial of the dependent benefits and entitlements until the service member is able to provide the required proofing documents.

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DD Form 137 7 Instructions

The DD 137-7 contains sixteen sections overall. No blocks should be left blank: put N/A in all items that are not relevant to your experience. Remember that all dates and signatures must be notarized.

  1. Section 1, Entitlements Requested, requires an X for each applicable entitlement, the date of the first application and status of the last application. BAH stands for Basic Allowance for Housing and USIP stands for Uniform Service Identification and Privilege Card or ID card.
  2. Section 2, Member Information, is for the name, DoD ID, rank, and status of the applicant. The place of residence, telephone, email and military service address are required to be correct - this information will be used for immediate communication.
  3. Section 3 applies only to the child (ward) and consists of 5 parts meant for providing their name, ID number, date of birth, residence address and status (married or unmarried, incapacitated, studying full-time).
  4. Section 4, Ward's Residence, must be filled out correctly. Forms are regularly rejected because of incorrect or incomplete information in this section.
  5. Section 5 is self-explanatory and applies only if the ward is a full-time student. The information required within the section includes the address while attending school, the type of residence, home address and the type of residence at that address.
  6. Section 6 is for listing all the people who live with the child including the child themselves. The section must not be left blank even if the service member and their child are the only residents of the household.
  7. Section 7 is the Household Expenses section. Be sure not to make errors, otherwise, your claim may be rejected. See Section 10 for additional information.
  8. Section 8 is for listing the ward's personal expenses. All expenses must be listed regardless of who pays for the items or services in question. These do not include the service member's personal expenses.
  9. Section 9 is for listing school expenses. All expenses should be accounted for, even those that are covered by a scholarship, grant or financial aid.
  10. Section 10 is self-explanatory. If the child is incapacitated and resides in a medical facility or institution full-time Section 7 must be left blank. If the child resides part-time at the facility then both Sections 7 and 10 must be completed. An official letter is required from the institution explaining all expenses and who pays for them.
  11. Section 11 is filed in cases if the claimed child had any occupation within the last 12 months. Otherwise, N/A is required in all boxes.
  12. Section 12 is self-explanatory and requires verification of school attendance. Supporting forms must have a school's header, name, and address, the status of the student, their graduation date and the school's official seal.
  13. Section 13 is for providing information on ane gross income made by or on behalf of the child whether taxable or not. Service members income should not be included in this section of the form.
  14. Section 14 is for providing information on all monetary contributions made by the service member for purposes of caring for the child for the last 12 months. Proof of support is required for BAH. Acceptable forms of proof are AD, canceled checks, money order receipts, and western union transfers. Joint checking accounts, cash contributions or purchases are not valid. Copies of bills paid for the dependent may be provided.
  15. Section 15 is for any additional remarks and Section 16 is for the signatures of all parties. All signatures and dates must be notarized.

DD 137-7 Related Forms

  1. DD Form 137-3, Dependency Statement - Parent is a form is used for determining the dependency status and benefits eligibility of claimed dependent parents.
  2. DD Form 137-5, Dependency statement - Incapacitated Child Over 21 is used for establishing entitlement of authorized benefits of claimed children over the age of 21.
  3. DD Form 137-6, Dependency Statement - Full Time Student 21 to 22 Years of Age is a form that determines the applicant's entitlement to authorized benefits on behalf of a full-time student between the ages of 21 and 22.
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Download DD Form 137-7 "Dependency Statement - Ward of a Court"

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OMB No. 0730-0014
DEPENDENCY STATEMENT - WARD OF A COURT
OMB approval expires
February 28, 2021
The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to
the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD
Pay and Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures –
Active Duty and Reserve Pay; and Joint Travel Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's
entitlement of authorized benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local
governmental agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal
prosecution, civil court action and regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344,
Defense Joint Military Pay System-Reserve Component; T7340, Defense Joint Military Pay System-Active Component; and M01040-3, Marine Corps
Manpower Management Information System Records, located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can
provide the required certificate.
INSTRUCTIONS: This form is used to determine Basic Allowance for Housing (BAH), travel allowances, and/or Uniformed Services Identification
and Privilege (USIP) card benefits for wards of a court. The member must complete the form as stated in Item 3, sign and date the form, and
have it notarized. Answer every question. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Report and verify any
income in gross amounts. Verification of income, proof of support and a copy of guardianship documents are required. In the case of a ward who is
a full-time student, supporting documentation must include a letter from the accredited college or university verifying the ward's full- time enrollment,
documentation of expenses, and any educational assistance that ward may receive. If the ward is incapacitated and over the age of 21, a
medical sufficiency statement from a military medical treatment facility is required.
1. ENTITLEMENTS REQUESTED
(X and complete as applicable)
a. TYPE
b. FIRST APPLICATION?
c. LAST APPLICATION WAS
BAH
USIP
YES
APPROVED
(If "NO," give date of last application)
TRAVEL ALLOWANCE
NO
DISAPPROVED
(YYYYMMDD)
2. MEMBER INFORMATION
b. DoD ID NUMBER
a. NAME (Last, First, Middle Initial)
c. RANK
d. STATUS (X and complete as applicable)
ACTIVE DUTY
NATIONAL GUARD
ARMY
NAVY
DECEASED (Date of death) (YYYYMMDD)
RETIRED
RESERVE
MARINE CORPS
AIR FORCE
OTHER (Specify)
e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)
h. E-MAIL ADDRESS
g. TELEPHONE NUMBERS (Include DSN or Area Code)
i. MARITAL STATUS (X)
(1) WORK
(2) HOME
SINGLE
SEPARATED
WIDOWED
MARRIED
DIVORCED
3. WARD INFORMATION
b. DoD ID NUMBER
a. NAME (Last, First, Middle Initial)
c. DATE OF BIRTH
(YYYYMMDD)
d. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
e. STATUS (X and complete as applicable)
UNMARRIED UNDER 21 YEARS OF AGE (Complete Items 1 - 8 and 13 - 16.)
21-22 YEARS OF AGE AND A FULL-TIME STUDENT (Complete Items 1 - 9 and 12 - 16.)
INCAPACITATED OVER AGE 21 (Complete Items 1 - 8 and 10 - 16.)
HAS WARD EVER BEEN MARRIED? (If "Yes," attach copy of annulment decree, final divorce decree, or death certificate of ward's spouse.)
YES
NO
DD FORM 137-7, MAR 2018
Page 1 of 5 Pages
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
OMB No. 0730-0014
DEPENDENCY STATEMENT - WARD OF A COURT
OMB approval expires
February 28, 2021
The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to
the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD
Pay and Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures –
Active Duty and Reserve Pay; and Joint Travel Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's
entitlement of authorized benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local
governmental agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal
prosecution, civil court action and regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344,
Defense Joint Military Pay System-Reserve Component; T7340, Defense Joint Military Pay System-Active Component; and M01040-3, Marine Corps
Manpower Management Information System Records, located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can
provide the required certificate.
INSTRUCTIONS: This form is used to determine Basic Allowance for Housing (BAH), travel allowances, and/or Uniformed Services Identification
and Privilege (USIP) card benefits for wards of a court. The member must complete the form as stated in Item 3, sign and date the form, and
have it notarized. Answer every question. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Report and verify any
income in gross amounts. Verification of income, proof of support and a copy of guardianship documents are required. In the case of a ward who is
a full-time student, supporting documentation must include a letter from the accredited college or university verifying the ward's full- time enrollment,
documentation of expenses, and any educational assistance that ward may receive. If the ward is incapacitated and over the age of 21, a
medical sufficiency statement from a military medical treatment facility is required.
1. ENTITLEMENTS REQUESTED
(X and complete as applicable)
a. TYPE
b. FIRST APPLICATION?
c. LAST APPLICATION WAS
BAH
USIP
YES
APPROVED
(If "NO," give date of last application)
TRAVEL ALLOWANCE
NO
DISAPPROVED
(YYYYMMDD)
2. MEMBER INFORMATION
b. DoD ID NUMBER
a. NAME (Last, First, Middle Initial)
c. RANK
d. STATUS (X and complete as applicable)
ACTIVE DUTY
NATIONAL GUARD
ARMY
NAVY
DECEASED (Date of death) (YYYYMMDD)
RETIRED
RESERVE
MARINE CORPS
AIR FORCE
OTHER (Specify)
e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)
h. E-MAIL ADDRESS
g. TELEPHONE NUMBERS (Include DSN or Area Code)
i. MARITAL STATUS (X)
(1) WORK
(2) HOME
SINGLE
SEPARATED
WIDOWED
MARRIED
DIVORCED
3. WARD INFORMATION
b. DoD ID NUMBER
a. NAME (Last, First, Middle Initial)
c. DATE OF BIRTH
(YYYYMMDD)
d. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
e. STATUS (X and complete as applicable)
UNMARRIED UNDER 21 YEARS OF AGE (Complete Items 1 - 8 and 13 - 16.)
21-22 YEARS OF AGE AND A FULL-TIME STUDENT (Complete Items 1 - 9 and 12 - 16.)
INCAPACITATED OVER AGE 21 (Complete Items 1 - 8 and 10 - 16.)
HAS WARD EVER BEEN MARRIED? (If "Yes," attach copy of annulment decree, final divorce decree, or death certificate of ward's spouse.)
YES
NO
DD FORM 137-7, MAR 2018
Page 1 of 5 Pages
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
4. WARD'S RESIDENCE
a. TYPE OF RESIDENCE (X and complete as applicable)
HOME OR APARTMENT OF MEMBER
HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)
HOME OR APARTMENT OF WARD
HOME OR APARTMENT OF FORMER SPOUSE OF MEMBER
STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY
HOSPITAL OR INSTITUTION
OTHER (Explain)
b. OWNER OF RESIDENCE
(1) NAME (Last, First, Middle Initial)
(2) ADDRESS (Street, Apartment Number, City, State, ZIP Code)
d. DATE WARD BEGAN LIVING AT CURRENT
e. DATE WARD BEGAN LIVING WITH PERSON WHO
c. IS RESIDENCE SUBSIDIZED HOUSING?
ADDRESS (YYYYMMDD)
CURRENTLY HAS PHYSICAL CUSTODY (YYYYMMDD)
YES
NO
5. IF WARD IS A FULL-TIME STUDENT
a. ADDRESS WHERE WARD RESIDES WHILE ATTENDING SCHOOL (Street, Apartment Number, City, State, ZIP Code)
b. TYPE OF RESIDENCE (X and complete as applicable)
WARD'S OWN HOME OR APARTMENT
STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY
MEMBER'S HOME OR APARTMENT
HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)
HOME OR APARTMENT OF MEMBER'S FORMER SPOUSE
HOME OR APARTMENT OF MEMBER'S WIDOW OR WIDOWER
OTHER (Explain)
c. ADDRESS WHERE WARD RESIDES WHILE NOT ATTENDING SCHOOL (Longer than 90 days) (Street, Apartment Number, City, State, ZIP Code)
d. TYPE OF RESIDENCE (X and complete as applicable)
WARD'S OWN HOME OR APARTMENT
STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY
MEMBER'S HOME OR APARTMENT
HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)
HOME OR APARTMENT OF MEMBER'S FORMER SPOUSE
HOME OR APARTMENT OF MEMBER'S WIDOW OR WIDOWER
OTHER (Explain)
6. PERSONS LIVING IN HOUSEHOLD WITH WARD
c. MARRIED (X)
d. EMPLOYED
a. NAME (Last, First, Middle Initial)
b. AGE
YES
NO
HOURS PER WEEK
NO (X)
7. HOUSEHOLD EXPENSES
List the household expenses for all persons living in the home. If expense was one-time only, such as purchase of a new chair, do not show this as
a monthly expense; list it as an expense for the past 12 months. If ward resides in the member's household or in a dwelling owned by member, use
Fair Rental Value (FRV) for dwelling. If ward does not reside in member's household or in a dwelling owned by member, list actual mortgage, rent, or
FRV if dwelling is mortgage-free. If FRV is used, give a brief explanation of how Fair Rental Value was obtained in the Remarks section.
FAIR RENTAL VALUE (FRV): FRV is a single monthly sum for the entire dwelling where the ward lives. This sum is an amount the owner can
reasonably expect to receive from a stranger to rent the dwelling. FRV will not include food, utilities, furniture, and home repairs, which are listed
separately.
PRESENT MONTHLY
TOTAL EXPENSE FOR
PRESENT MONTHLY
TOTAL EXPENSE FOR
ITEM
ITEM
EXPENSE
PAST 12 MONTHS
EXPENSE
PAST 12 MONTHS
a. (X one)
RENT
FRV
d. FURNITURE/APPLIANCES
MORTGAGE
(Specify amount of tax and
insurance if applicable)
e. REPAIRS ON HOME
TAX
f. OTHER (Specify)
INSURANCE
b. FOOD
c. UTILITIES (Heat, power,
water, and telephone)
DD FORM 137-7, MAR 2018
Page 2 of 5 Pages
8. WARD'S PERSONAL EXPENSES
List personal expenses for ward. Do not list personal expenses for the member, his or her immediate family, or any other person. List all of the
ward's personal expenses regardless of who is paying for them.
PRESENT MONTHLY
TOTAL EXPENSE FOR
PRESENT MONTHLY
TOTAL EXPENSE FOR
ITEM
ITEM
EXPENSE
PAST 12 MONTHS
EXPENSE
PAST 12 MONTHS
g. PRIVATE AUTO PAYMENTS
a. CLOTHING
(If auto is registered in
ward's name)
b. LAUNDRY AND DRY
CLEANING
h. MONTHLY TRANSPORTA-
TION PAYMENTS (Include
c. MEDICAL (Do not include
gas, oil, insurance, repairs,
expenses paid by insurance,
and public transportation)
welfare, or Medicare)
i. SCHOOL EXPENSES (Itemize)
d. VALUE OF USIP CARD
(Verification of amount is
required)
e. PERSONAL INSURANCE
(Specify)
j. OTHER EXPENSES (Itemize)
f. PERSONAL TAXES (Specify)
9. WARD'S SCHOOL EXPENSES
List ward's school expenses even if covered by scholarship, grant, or other financial aid.
AVERAGE MONTHLY
AVERAGE MONTHLY
ITEM
ITEM
EXPENSE
EXPENSE
a. TUITION
e. BOARD (Food)
f. OTHER SCHOOL EXPENSES (Specify)
b. BOOKS
c. SPECIAL FEES
d. ROOM (Rent)
10. IF WARD IS IN HOSPITAL OR INSTITUTION (INCAPACITATED)
If ward is in a hospital or institution, all of the following information must be furnished. Obtain this information from the hospital or institution.
a. DATE WARD ENTERED HOSPITAL/INSTITUTION (YYYYMMDD)
b. ANTICIPATED DATE OF DISCHARGE (If known)
c. WILL WARD RETURN TO MEMBER'S HOME AFTER DISCHARGE? (If "NO," explain where ward will reside)
YES
NO
d. WARD'S EXPENSES IN HOSPITAL OR INSTITUTION
PRESENT MONTHLY
TOTAL EXPENSE FOR
PRESENT MONTHLY
TOTAL EXPENSE FOR
ITEM
ITEM
EXPENSE
PAST 12 MONTHS
EXPENSE
PAST 12 MONTHS
(1) ROOM
(8) EDUCATION
(2) FOOD
(9) TRANSPORTATION
(10) PERSONAL INSURANCE
(3) REHABILITATION CLASSES
(Specify)
OR SERVICES
(4) SPECIALIZED EQUIPMENT
(11) OTHER (Specify)
(5) MEDICAL CARE
(6) CLOTHING
(7) LAUNDRY/DRY CLEANING
DD FORM 137-7, MAR 2018
Page 3 of 5 Pages
10.e. WARD'S EXPENSE IN HOSPITAL OR INSTITUTION ARE PAID BY:
TOTAL EXPENSE
TOTAL EXPENSE
PRESENT MONTHLY
PRESENT MONTHLY
FOR PAST 12
FOR PAST 12
SOURCE
SOURCE
EXPENSE
EXPENSE
MONTHS
MONTHS
(4) STATE OR LOCAL AGENCY
U
(1) CIVILIAN MEDICAL
S
(Name and Address)
TREATMENT FACILITY
I
P
(CHAMPUS)
C
(2) MILITARY MEDICAL
A
R
TREATMENT FACILITY
D
(5) MEMBER
(3) PRIVATE INSURANCE
(Name and Address)
(6) OTHER (Explain and give
name and address)
11. WARD'S EMPLOYMENT
Has ward been employed since age 21?
YES
NO
If "YES," furnish the following information. Use the Remarks section to continue if necessary.
(1) NAME OF EMPLOYER
(2) DATE EMPLOYMENT STARTED
(3) DATE ENDED
(4) MONTHLY SALARY (Gross)
a.
(5) TYPE OF WORK PERFORMED
(6) REASON EMPLOYMENT ENDED
(1) NAME OF EMPLOYER
(2) DATE EMPLOYMENT STARTED
(3) DATE ENDED
(4) MONTHLY SALARY (Gross)
b.
(5) TYPE OF WORK PERFORMED
(6) REASON EMPLOYMENT ENDED
(1) NAME OF EMPLOYER
(2) DATE EMPLOYMENT STARTED
(3) DATE ENDED
(4) MONTHLY SALARY (Gross)
c.
(5) TYPE OF WORK PERFORMED
(6) REASON EMPLOYMENT ENDED
d. IS OR WAS WARD'S JOB CONSIDERED AS BEING A "SHELTERED WORKSHOP" - THAT IS, OPEN ONLY TO DISABLED OR HANDICAPPED PEOPLE?
YES (If "YES" and ward is currently working, attach a statement from the employer verifying this information.)
NO
12. WARD'S SCHOOL ATTENDANCE
Has ward attended college since age 21?
If "YES," furnish the following information.
YES
NO
(1) NAME AND ADDRESS OF SCHOOL
(2) (X as applicable)
VOCATIONAL
a.
FOR RECEIVING DEGREE
(3) DATES ATTENDED
(5) WARD'S MAJOR
(4) (X)
FULL-TIME
PART-TIME
(1) NAME AND ADDRESS OF SCHOOL
(2) (X as applicable)
VOCATIONAL
b.
FOR RECEIVING DEGREE
(3) DATES ATTENDED
(5) WARD'S MAJOR
(4) (X)
FULL-TIME
PART-TIME
13. WARD'S INCOME
All gross income received by or in behalf of the ward, whether taxable or nontaxable, and whether received monthly, quarterly, or yearly, must be
listed. This includes any income received by persons in the capacity of custodian or administrator for the ward. If any income received during the past
12 months was a lumpsum (one-time) payment, be sure to state this. Verification documents are required.
TOTAL INCOME
TOTAL INCOME
PRESENT MONTHLY
PRESENT MONTHLY
FOR PAST 12
FOR PAST 12
SOURCE
SOURCE
INCOME
INCOME
MONTHS
MONTHS
d. SOCIAL SECURITY PAYMENTS,
a. WAGES, SALARIES, TIPS, OR
DISABILITY OR REGULAR
OTHER CASH GRATUITIES
(Specify)
b. INTEREST ON INVESTMENTS,
BONDS, SAVINGS, TRUST
FUNDS, ETC.
e. SUPPLEMENTAL SECURITY
c. INSURANCE OR PUBLIC/
INCOME (SSI)
GOVERNMENT PENSION
f. VETERANS ADMINISTRATION
PAYMENTS, UNEMPLOYMENT
OR DISABILITY COMPENSATION
PAYMENTS (Specify type)
(Specify type)
DD FORM 137-7, MAR 2018
Page 4 of 5 Pages
13. WARD'S INCOME
(Continued)
TOTAL INCOME
TOTAL INCOME
PRESENT MONTHLY
PRESENT MONTHLY
FOR PAST 12
FOR PAST 12
SOURCE
SOURCE
INCOME
INCOME
MONTHS
MONTHS
j. STATE OR LOCAL WELFARE AID,
g. CONTRIBUTIONS FROM
INCLUDING AID TO DEPENDENT
PERSONS OTHER THAN
CHILDREN (Include agency and
h. SCHOLARSHIPS OR
address in Remarks section)
k. OTHER (Specify)
EDUCATIONAL GRANTS
i. TAX REFUNDS (Specify)
14. MEMBER'S CONTRIBUTION
a. SHOW THE TOTAL AMOUNT THE MEMBER HAS CONTRIBUTED TO THE WARD'S SUPPORT FOR EACH OF THE PAST 12 MONTHS.
MONTH AND YEAR
AMOUNT
MONTH AND YEAR
AMOUNT
MONTH AND YEAR
AMOUNT
b. MEMBER PROVIDES SUPPORT BY (X one)
ALLOTMENT
MONEY ORDER
PERSONAL CHECK
OTHER (Explain)
15. REMARKS
16. SIGNATURES
Read the penalty provisions, sign and date the form, and have it notarized.
NOTE: Whoever, in any matter within the jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals, or
covers up by any trick, scheme, or device, a material fact, or makes any false, fictitious, or fraudulent statements or representations, or makes or
uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined as provided in Title
18, or imprisoned not more than 5 years, or both (U.S. Code, title 18, section 1001). The information provided in this form may be referred to the
appropriate Military Service investigative agency.
I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. (U.S. Code, title 18, section
287, formerly section 80, provides a penalty as follows: Imprisonment for not more than five years and subject to a fine in the amount
provided in this title.)
a. CUSTODIAN
(print name(s)) will immediately notify
I/we
the service concerned of any change in child's financial circumstances, marital status, physical custody, or change in dependency upon the service
member as shown in this form.
(1) SIGNATURE OF PERSON WHO HAS CUSTODY OF THE WARD (Can be member or other than member)
(2) DATE SIGNED (YYYYMMDD)
b. NOTARY PUBLIC
Subscribed and duly sworn (or affirmed) to before me according to law by the above named affiant(s).
This
day of
,
, at city (or town) of
, county of
,
and state (or territory) of
.
(Notary)
(Official Seal)
(Official Title)
My commission expires:
c. MEMBER
(1) SIGNATURE
(2) DATE SIGNED (YYYYMMDD)
DD FORM 137-7, MAR 2018
Page 5 of 5 Pages
Page of 5