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S Name (Last, First, MI) 5. ETS Date 6. Unit 6a. Soldier s Home or Permanent Mailing Address, Phone # and Email 7. Bankruptcy Filed or Pending? Are you currently in Bankruptcy? No Yes If yes, what Chapter? Do you intend to file Bankruptcy within the next six months? Yes No 8. Reason Why Assistance is Needed (Be complete and specific. If more space is needed, continue on separate sheet) 8a. Dependents for Whom You Furnish More Than One-Half Support (ID Card Holder):.

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