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A. NAME OF PERSON(S) OR ORGANIZATION B. ADDRESS OF PERSON(S) OR ORGANIZATION |
Brown & White Law Firm 789 W 42nd St, Charlottesville, VA |
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10. SPECIFY THE SECURITY QUESTION YOU WANT USED WHEN VERIFYING THE IDENTITY OF YOUR DESIGNATED THIRD PARTY. CHECK ONLY ONE SECURITY QUESTION BOX IN 10A AND PROVIDE THE ANSWER IN 10B. (Veteran/annuitant should answer the question and inform third-party of the answer.) |
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A. SECURITY QUESTION B. ANSWER |
[] The city and state your mother was born in ___ |
[] The name of the high school you attended ___ |
[x] Your first pet's name Fluffy |
[] Your favorite teacher's name ___ |
[] Your father's middle name ___ |
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11A. SIGNATURE (Sign in ink) |
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11B. DATE SIGNED |
10-28-25 |
PRIVACY ACT INFORMATION: No insurance may be converted unless a completed application form has been received (38 U.S.C. 1904 and 1942). The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5, Code of Federal Regulations 1.52... |
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control Number. The OMB control number for this project is 2900-0856, and it expires 04/30/2027. Public reporting burden for this collection of informa... |
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VA FORM |
APR 2024 |
29-0975 |
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Page 2 |
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--------------------------------------------------- Unstructured Plain Text Format 1.0.4 |
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+12V 1 |
U2 +12V 9 D1 2 1 |
GND 7 5 3 |
C1 2 1 10uF |
C2 2 1 10uF |
1 GND |
–12V 1 D4 1 2 |
D3 2 1 |
–12V 1 |
1 GND |
+12V 1 |
C4 2 1 100nF |
U1 V+ 8 V– 4 |
1 GND |
C6 2 1 100nF |
–12V 1 |
+12V 1 |
U3 V+ 4 |
V– 11 |
C3 2 1 100nF |
1 GND |
C5 2 1 100nF |
–12V 1 |
U3.4 |
2 –A 1 |
3 + |
1 GND |
+12V 1 |
2k 2 1 R1 |
U1.1 |
2 –A 3 + 1 |
+5V 1 |
REF+5 |
100k 1 2 |
100k 1 2 |
–5V 1 |
U1.2 |
6 – B 5 + 7 |
1 GND |
10k 2 1 R4 |
2 1 3 D2 CJ431 |
10k 2 1 R5 |
1 GND |
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