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Forms/App for Vets Credit—2-09 SCHUYLER COUNTY CIVIL SERVICE DEPARTMENT 105 Ninth Street, Unit 21 Watkins Glen, NY 14891 (607) 535-8190 Fax: (607) 535-8193 E-Mail: [EMAIL REDACTED] APPLICATION FOR VETERANS CREDIT Answer every question. Submit copy of discharge document (DD 214). Name (print clearly) Social Security Number Legal Address Street City State Zip Mailing Address (if different) Service Serial Number Date of Birth Dates of Active Service From: To: Residence on Date of Entry—Military Service County: State: Credits Claimed (Check One) Non-Disabled Veteran Disabled Veteran If you are claiming credits as a Disabled Veteran: V.A. Claim No. Have you sent Disability Record Authorization to V.A.? Yes No 7. List ALL of your periods of public service employment since January 1, 1951. Dates Employer Name and Address Title of Your Position Veterans Credit Used From To Yes No I declare, subject to the penalties of perjury, that the statements made on this form and any attachments are to the best of my knowledge true and correct. Signature Date For Civil Service Use Only Date By Veteran credits approved Disabled veteran credits approved Credits recorded on eligible list