2. Claim is Hereby Submitted for

   1. Disabled Veteran’s Credit
   2. Nondisabled Veteran’s Credit
3. Veterans Signature
   By typing your name into this field you authorize Yates County to consider this an electronic signature.
5. Address
7. City
8. State
9. Zip Code
11. Veterans Administration Claim Number
12. Service Serial Number
14. Examination or Eligible List for Which Preference is Claimed
    Exam Number and Title
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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