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2. Person submiting form
   Please insert your name if you are not the veteran.
3. Todays Date*
   Todays Date
   Please select todays date
5. Veteran's First Name
6. Veterans's Last Name
8. Street Number
9. Street Name
10. Day time phone number
11. Cell phone number
13. City
14. State
15. Zip
17. Your Email Address*
    Please enter your email address here
19. Branch of Service*
    -- Select One --Air ForceArmyCoast GuardMarinesNavy

    Please select your branch of service
20. Your military service dates*
    Your military service dates Start Date

    —

    Your military service dates End Date
    Please select the date you joined the military and discharge date
22. WHERE WERE YOU BORN? HOW DID YOU COME TO BE IN LIVINGSTON COUNTY?
24. WHERE DID YOU GRADUATE FROM HIGH SCHOOL?
26. WHERE DID YOU SERVE?
28. WHAT MEDALS/CERTIFICATES/HONORS DID YOU RECIEVE?
30. WHAT DID YOU DO AFTER MILITARY SERVICE?
32. WHAT DO YOU DO NOW?
    WHAT DO YOU DO FOR HOBBIES? DO YOU VOLENTEER IN YOU COMMUNITY?
34. DO YOU HAVE A SPOUSE/CHILDREN/GRANDCHILDREN?
    WHAT ARE THE NAMES OF YOUR SPOUSE AND CHILDREN? HOW MANY GRANDCHILDREN DO YOU HAVE?
36. DO YOU HAVE A COPY OF YOUR DD 214?

    1. YES

    1. NO
37. DO YOU WANT AN APPOINTMENT TO DISCUSS POSSIBLE BENEFITS?

    1. YES

    1. NO
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field