Fillable AUTHORIZATION AND CONSENT TO RELEASE INFORMATION TO ... - vba va
This is not required by VA but may be required by the source of the information. 12B. DATE VA FORM 21-4142 FEB 2012 PAGE 2. COMMENTS YOU MUST SIGN AND DATE THIS FORM ON PAGE 2 AND CHECK THE APPROPRIATE BLOCK IN ITEM 10C. VA FORM FEB 2012 21-4142 Existing stocks of the VA Form 21-4142 JAN 2011 will be used. PAGE 1 SECTION III - CONSENT TO RELEASE INFORMATION READ ALL PARAGRAPHS CAREFULLY BEFORE SIGNING. YOU MUST ...
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