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Signature I hereby certify that the within claim is in proper form duly authenticated as required by law based upon statutory authority and is apparently correct in accordance with IC 5-11-10-2. Reset Form ON ACCOUNT OF APPROPRIATION FOR BURIAL OF VETERANS State Form 49890 R2 / 5-11 Approved by State Board of Accounts 2011 DEPARTMENT OF VETERANS AFFAIRS This agency is requesting disclosure of your Social Security Number in accordance with IC 4-1-8-1 disclosure is mandatory and this record...
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