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-- <br />SUNRISE VILLAGE <br />VETERANS ADM MSTRATION BENEFIT VERIFICATION DATA <br />1. Periods of Active Duty. From To . From To <br />2. Allowance for Education or Training: School (); On the Job () <br />Monthly Amount: $ Effective Date of Current Award: <br />3. Compensation (service connected): Disability() Death () <br />Pension ( non-service.connected): <br />Effective Date of Current Award: <br />Dependency & Indemnity () <br />Disability () Death () <br />Monthly Amt: $ <br />4. Other Payments (Mo. Insurance, etc.): <br />Monthly Amt: $ <br />5. Changes: If any change is contemplated, check here () and explain on reverse side. <br />6. Remarks: (If any) <br />Veterans Administration <br />By. <br />Date: Title: <br />We are pledged to the letter and spirit of U.S. Policy for achievement of equal housing opportunity <br />throughout the Nation We encourage and support an affirmative advertising and marketing program in <br />which there are no barriers to obtaining housing because of race, color, religion, sex, handumA familial <br />status or national origin. <br />DOC 220 <br />