THE AMERICAN LEGION
DEPARTMENT OF VERMONT
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Veterans Administration
White River Jct., VT 05009
(802) 296-5166
Toll Free: 877-600-1514
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APPLICATION FOR AMERICAN LEGION DEPT. OF VERMONT
TEMPORARY FINANCIAL ASSISTANCE
DATE:___________________
NAME: _____________________________________________
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ADDRESS: __________________________________________
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PHONE #: ________________
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TOWN/CITY: ________________________________________
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ZIP: _____________________
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AMERICAN LEGION POST #: __________
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CARD #: _________________
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YEARS OF MEMBERSHIP: _____________
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SPOUSE'S NAME: ___________________________________
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# OF DEPENDENTS: _________________________
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AGES: _______________
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REASON FOR THE NEED OF FINANCIAL ASSISTANCE:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Use additional sheets as needed.
FORM PREPARED BY: ________________________
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SERVICE OFFICER POST #: _______
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APPROVED BY:
______________________________________
______________________________________
______________________________________
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AMERICAN LEGION D.S.O.
REHAB CHAIRMAN
MEMBER
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DATE APPROVED: __________________________
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AMOUNT OF ASSISTANCE: $__________________
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CHECK #: ___________________
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Mail to:
Milton Willis, DSO
The American Legion (74)
215 No. Main St.
White Rivr Jct VT 05009
