Surviving Spouse / Relative Intake | Johnston County Veterans Services

Your Information (Surviving Spouse / Relative)

Your First Name (required)

Your Middle Name

Your Last Name (required)

Suffix

Your SSN (required — formats as 123-45-6789)

Your Date of Birth (required)

Your Sex

Male Female

Your Relationship to the Veteran (required)

Your Contact Information

Phone Number (required)

Email Address (required)

Home Street Address (required)

City (required)

State (required)

Zip Code (required)

County (required)

Country

US Other

Is your mailing address the same as your home address? (required)

Yes No

Deceased Veteran's Information

Veteran's First Name (required)

Veteran's Middle Name

Veteran's Last Name (required)

Veteran's Suffix

Veteran's SSN (required — formats as 123-45-6789)

VA File / Claim Number (if known)

Veteran's Date of Birth

Veteran's Date of Death (required)

Branch of Service

Rank

Service Entry Date

Service Separation Date

Character of Discharge

Conflict / Era of Service

Benefits Sought & Info for the VSO

Check any survivor benefits you'd like help with. This helps the Service Officer prepare for your appointment.

Dependency & Indemnity Compensation (DIC) Survivors Pension Burial & Memorial Benefits Education (DEA / Fry Scholarship) Home Loan Guaranty CHAMPVA / Healthcare Accrued Benefits Other / Not Sure

Do you have the veteran's DD-214?

Yes No

Do you have the veteran's death certificate?

Yes No

Upload supporting documents (optional)
If you have any of these now, you can attach them and the office can review them before your appointment. You can also simply bring them with you. Accepted: PDF, JPG, or PNG, up to 10 MB each.

Veteran's DD-214

Death certificate

Marriage certificate

Other supporting documents (you may select more than one)

What would you like to discuss during your appointment?
Please include any relevant topics, documents, concerns, or goals. (required)