Iii) If Discharged Prior to 1950 a Certificate of Discharge

APPENDIX - A

Documents Needed for Verification (Only one document is needed for each category unless otherwise noted.)

a) Proof of service

i) DD-214 or equivalent

ii) VA Statement of Service (SOS)

iii) If discharged prior to 1950 a Certificate of Discharge

iv) Photo ID Veterans Affairs Medical Card.

b) Verification of Residency

i) Utility Bill

ii) Washington State Drivers

iii) DSHS verification printout

iv) Social Security documentation

v) Military disability documentation

vi) W-2 form for prior year

vii) Homeless veterans would have to have mail delivered to city or post office within county.

viii) State ID card

ix) Rental agreement

c) Picture ID

i) Washington State Driver’s License

ii) State I.D. card (Department of Corrections, College,

iii) Military ID card if in National Guard

iv) VA medical ID

v) Any ID not list has to have SSN# that matches or verifying information unique to that veteran (signature, service number, etc.)

d) Proof of Marriage

i) Marriage Certificate

ii) Tax Return with married filing jointly

iii) Military Spouses ID card

iv) DSHS verification form with both names on it

v) Death certificate

e) Verification of Dependent

i) Birth Certificate

ii) Dependent Military ID

iii) Adoption paperwork

iv) Verification from school district (This is for grandparents or nonparent custodial who is main supply of benefits for children but cannot acquire other documents.)

v) DSHS(Department of Social and Health Services) Income verification

vi) SSDI (Social Security Disability Income)

vii) Death Certificate

f) Death Verification

i) Death Certificate

h) Income Verification Documents

i) Bank statement for the last three months

ii) If no bank account DSHS verification of income printout.

g) ( for over 18 years of age who are considered disabled dependents)

i) DSHS Income verification

ii) SSDI income verification

i) Income Verification continued (all that apply of the following documents minimum of one if no bank account)

i) W-2 withholding statement from all employers for the previous year

ii) Pay stubs from all employers for the previous year

iii) An income tax return from most recently filed calendar year

iv) Forms approving or denying eligibility for Medicaid and/or state funded assistance

v) Forms approving or denying unemployment compensation

vi) Written statement from all employers for the previous year or welfare agencies

vii) Temporary assistance for needy families, aged, blind, or disabled assistance

viii) Pregnant women assistance benefits

ix) Poverty-related veteran’s benefits

x) Refugee resettlement benefits

xi) Supplemental Social Security Income (SSI)

xii) Social Security Disability Income (SSDI)

xiii) Retirement documents such as pension.

xiv) Military Disability letter with percentage and amount received

Appendix- B

Appeal Form for Veterans Relief Fund

Veteran or person appealing the Veteran Relief Fund decision

Name:
Last / First / Middle / Date
What is being appealed:
Why is this decision being appealed:
Attach additional sheets if needed
Decision made by Veteran Advisory Board (VAB):
Date:
Chairman of the Board / Health Department Director
Board Member / Board Member / Board Member
Board Member / Board Member / Board Member