Dd Form 137 7 2008-2026

DD FORM 137-7 JAN 2008 PREVIOUS EDITION IS OBSOLETE. Reset Page 1 of 5 Pages Adobe Professional 7. 0 4. I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. U.S. Code title 18 section 287 formerly section 80 provides a penalty as follows Imprisonment for not more than five years and subject to a fine in the amount provided in this title. a. CUSTODIAN print name s will immediately notify I/we the service concerned of any change in child s financial circumstances marital status physical custody or change in dependency upon the service member as shown in this form. 1 SIGNATURE OF PERSON WHO HAS CUSTODY OF THE WARD Can be member or other than member 2 DATE SIGNED YYYYMMDD b. NOTARY PUBLIC Subscribed and duly sworn or affirmed to before me according to law by the above named affiant s. The information provided in this form may be referred to the appropriate Military Service investigative agency. I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. U.S. Code title 18 section 287 formerly section 80 provides a penalty as follows Imprisonment for not more than five years and subject to a fine in the amount provided in this title. a. CUSTODIAN print name s will immediately notify I/we the service concerned of any change in child s financial circumstances marital status physical custody or change in dependency upon the service member as shown in this form. 1 SIGNATURE OF PERSON WHO HAS CUSTODY OF THE WARD Can be member or other than member 2 DATE SIGNED YYYYMMDD b. MEMBER S CONTRIBUTION a. SHOW THE TOTAL AMOUNT THE MEMBER HAS CONTRIBUTED TO THE WARD S SUPPORT FOR EACH OF THE PAST 12 MONTHS. MONTH AND YEAR AMOUNT b. MEMBER PROVIDES SUPPORT BY X one ALLOTMENT MONEY ORDER PERSONAL CHECK 15. REMARKS 16. SIGNATURES Read the penalty provisions sign and date the form and have it notarized. NOTE Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals or covers up by any trick scheme or device a material fact or makes any false fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing the same to contain any false fictitious or fraudulent statement or entry shall be fined as provided in Title 18 or imprisoned not more than 5 years or both U.S. Code title 18 section 1001. The information provided in this form may be referred to the appropriate Military Service investigative agency. CONTRIBUTIONS FROM PERSONS OTHER THAN h. SCHOLARSHIPS OR EDUCATIONAL GRANTS i. TAX REFUNDS Specify 14. MEMBER S CONTRIBUTION a. SHOW THE TOTAL AMOUNT THE MEMBER HAS CONTRIBUTED TO THE WARD S SUPPORT FOR EACH OF THE PAST 12 MONTHS. MONTH AND YEAR AMOUNT b. MEMBER PROVIDES SUPPORT BY X one ALLOTMENT MONEY ORDER PERSONAL CHECK 15. REMARKS 16. SIGNATURES Read the penalty provisions sign and date the form and have it notarized. NOTE Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals or covers up by any trick scheme or device a material fact or makes any false fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing the same to contain any false fictitious or fraudulent statement or entry shall be fined as provided in Title 18 or imprisoned not more than 5 years or both U.S. Code title 18 section 1001. The member must complete the form as stated in Item 3 sign and date the form and have it notarized. Answer every question. If any question does not apply write NOT APPLICABLE or N/A in that block. Report and verify any income in gross amounts. Verification of income proof of support and a copy of guardianship documents are required. In the case of a ward who is a full-time student supporting documentation must include a letter from the accredited college or university verifying the ward s full- time enrollment documentation of expenses and any educational assistance that ward may receive. If the ward is incapacitated and over the age of 21 a medical sufficiency statement from a military medical treatment facility is required. 1. DISCLOSURE Voluntary however failure to provide this information will result in a suspension of the dependent entitlement until the military member provides the required certification. INSTRUCTIONS This form is used to determine Basic Allowance for Housing BAH travel allowances and/or Uniformed Services Identification and Privilege USIP card benefits for wards of a court. The member must complete the form as stated in Item 3 sign and date the form and have it notarized. Answer every question. If any question does not apply write NOT APPLICABLE or N/A in that block. Report and verify any income in gross amounts. Verification of income proof of support and a copy of guardianship documents are required. In the case of a ward who is a full-time student supporting documentation must include a letter from the accredited college or university verifying the ward s full- time enrollment documentation of expenses and any educational assistance that ward may receive. A. CUSTODIAN print name s will immediately notify I/we the service concerned of any change in child s financial circumstances marital status physical custody or change in dependency upon the service member as shown in this form. 1 SIGNATURE OF PERSON WHO HAS CUSTODY OF THE WARD Can be member or other than member 2 DATE SIGNED YYYYMMDD b. NOTARY PUBLIC Subscribed and duly sworn or affirmed to before me according to law by the above named affiant s. day of This and state or territory of at city or town of county of. Notary Official Seal Official Title My commission expires c. MEMBER.