VA Form 29-541 "Certificate Showing Residence and Heirs of Deceased Veteran or Beneficiary"

What Is VA Form 29-541?

This is a legal form that was released by the U.S. Department of Veterans Affairs on May 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2018;
  • The latest available edition released by the U.S. Department of Veterans Affairs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of VA Form 29-541 by clicking the link below or browse more documents and templates provided by the U.S. Department of Veterans Affairs.

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Download VA Form 29-541 "Certificate Showing Residence and Heirs of Deceased Veteran or Beneficiary"

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OMB Control No. 2900-0469
Respondent Burden: 30 Minutes
Expiration Date: 05/31/2021
1. INSURANCE FILE NUMBER
CERTIFICATE SHOWING RESIDENCE AND HEIRS OF
(First, Middle, Last)
2. NAME OF INSURED
DECEASED VETERAN OR BENEFICIARY
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, 36VA00, Veterans and Armed Forces Personnel U.S.
Government Life Insurance Records - 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.
4A. ARE THERE HEIRS TO THIS ESTATE?
3. THE QUESTIONS REFER TO THE ESTATE OF:
(Give first, middle, last name)
YES
NO
4B. HAS THERE BEEN OR WILL THERE BE A COURT-APPOINTED EXECUTOR OR
ADMINISTRATOR APPOINTED FOR THIS ESTATE?
(If "Yes," see note below. If "No," complete remaining items)
YES
NO
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.
5. STATE OF RESIDENCE AT TIME OF DEATH (EXCLUDING MILITARY SERVICE)
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.
6. SPOUSE OF DECEASED VETERAN/BENEFICIARY
A. NAME OF SPOUSE
B. AGE
C. ADDRESS
E. YEAR OF MARRIAGE
D. DATE OF DEATH
(If deceased)
7. CHILD(REN) OF DECEASED VETERAN/BENEFICIARY
A. NAME(S) OF CHILD(REN)
D. DATE OF
E. PARENTS OF
(Include illegitimate, adopted
B. AGE
C. ADDRESS
DEATH
CHILD(REN)
and unborn child(ren))
(If deceased)
8. PARENTS OF DECEASED VETERAN/BENEFICIARY
D. DATE OF DEATH (If deceased)
A. NAME OF PARENT
B. AGE
C. ADDRESS
PARENT(S)
PARENT(S)
IMPORTANT: If spouse, child(ren), or parent(s) survive the insured, skip to Item 11A on the reverse.
VA FORM
SUPERSEDES VA FORM 29-541, JUN 2014,
29-541
(Continued on Reverse)
MAY 2018
WHICH WILL NOT BE USED.
OMB Control No. 2900-0469
Respondent Burden: 30 Minutes
Expiration Date: 05/31/2021
1. INSURANCE FILE NUMBER
CERTIFICATE SHOWING RESIDENCE AND HEIRS OF
(First, Middle, Last)
2. NAME OF INSURED
DECEASED VETERAN OR BENEFICIARY
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, 36VA00, Veterans and Armed Forces Personnel U.S.
Government Life Insurance Records - 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.
4A. ARE THERE HEIRS TO THIS ESTATE?
3. THE QUESTIONS REFER TO THE ESTATE OF:
(Give first, middle, last name)
YES
NO
4B. HAS THERE BEEN OR WILL THERE BE A COURT-APPOINTED EXECUTOR OR
ADMINISTRATOR APPOINTED FOR THIS ESTATE?
(If "Yes," see note below. If "No," complete remaining items)
YES
NO
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.
5. STATE OF RESIDENCE AT TIME OF DEATH (EXCLUDING MILITARY SERVICE)
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.
6. SPOUSE OF DECEASED VETERAN/BENEFICIARY
A. NAME OF SPOUSE
B. AGE
C. ADDRESS
E. YEAR OF MARRIAGE
D. DATE OF DEATH
(If deceased)
7. CHILD(REN) OF DECEASED VETERAN/BENEFICIARY
A. NAME(S) OF CHILD(REN)
D. DATE OF
E. PARENTS OF
(Include illegitimate, adopted
B. AGE
C. ADDRESS
DEATH
CHILD(REN)
and unborn child(ren))
(If deceased)
8. PARENTS OF DECEASED VETERAN/BENEFICIARY
D. DATE OF DEATH (If deceased)
A. NAME OF PARENT
B. AGE
C. ADDRESS
PARENT(S)
PARENT(S)
IMPORTANT: If spouse, child(ren), or parent(s) survive the insured, skip to Item 11A on the reverse.
VA FORM
SUPERSEDES VA FORM 29-541, JUN 2014,
29-541
(Continued on Reverse)
MAY 2018
WHICH WILL NOT BE USED.
9. BROTHER(S) AND SISTER(S) OF DECEASED VETERAN/BENEFICIARY
(STATE WHETHER FULL, HALF-BLOOD, OR ADOPTED)
A. NAME(S) OF BROTHER(S) AND
B. AGE
C. ADDRESS
D. DATE OF DEATH (If deceased)
SISTER(S)
NAME(S) OF CHILD(REN)
OF DECEASED BROTHER(S)
AND SISTER(S)
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.
10. FIRST WITNESS INFORMATION
11. SECOND WITNESS INFORMATION
A. FIRST, MIDDLE, LAST NAME
A. FIRST, MIDDLE, LAST NAME
(Include Area Code)
(Include Area Code)
B. DAYTIME TELEPHONE NUMBER
B. DAYTIME TELEPHONE NUMBER
C. RELATIONSHIP TO DECEASED
C. RELATIONSHIP TO DECEASED
(Sign in ink)
(Sign in ink)
D. SIGNATURE
D. SIGNATURE
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.
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/.
VA FORM 29-541, MAY 2018
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