CHILD ANNUITANT SCHOOL CERTIFICATION FOR PREVIOUS ATTENDANCE updated April 13

 DEFENSE FINANCE AND ACCOUNTING SERVICE U.S. Military Annuitant Pay 8899 E 56th Street Indianapolis IN 46249-1300 www.dfas.mil/retiredmilitary

Date April 10, 2020

Dear John M. Adams:

Since you are between ages 18 and 22, you are only entitled to receive annuity payments if you are unmarried and attend school full time. You have already received annuity payments based on a previous declaration of an intent to attend school on a full time basis as an unmarried person. The purpose of this document is to confirm the past school attendance for which you have already received payments. Completion of this information is mandatory and must be received within 60 days from the date of this document. Failure to complete and submit this document, along with DD FORM 2788, Child Annuitant’s School Certification (used to document your intent for future school attendance), will result in suspension of the annuity, cause us to question your entitlement to the annuity payments that we have already paid (based on your earlier declaration of an intent to attend school) and may result in an obligation to repay annuity payments already received.

Upon completion of this document, please submit it, along with DD Form 2788, Child Annuitant’s School Certification (if you intend to declare your future intent to attend school on a full time basis for the coming school year) by fax at 800-982-8459 or by mail to U.S. Military Annuitant Pay 8899 E 56^th Street Indianapolis, IN 46249-1300 within 60 days from the date of above.

The information stated below is what DFAS has on record based on the prior DD Form 2788, Child Annuitant’s School Certification, you submitted for the previous school year.

MEMBER'S SSN: 123456789 MEMBER'S NAME: Adams, Thomas L. ANNUITANT'S NAME: Adams, John M.

NAME OF SCHOOL: Ohio State University

PRIOR PERIOD OF SCHOOL ATTENDANCE (Based on your prior declaration of intent)

DATE SCHOOL YEAR BEGAN: 08/26/2019

DATE SCHOOL YEAR ENDED: 5/15/2020

ACADEMIC WORKLOAD LEVEL: Full Time

ANNUITANT’S MARITAL STATUS: Unmarried

By signing below you are certifying that all information previously provided is true and correct to the best of your knowledge and belief. You are also certifying that you acknowledge that you must immediately notify the Defense Finance and Accounting Service (DFAS) if you transfer to another school, discontinue school attendance, reduce attendance to less than full-time or marry. You further agree to return all overpayments of student benefits to which you are not entitled under the law. Any intentionally false statement, willful concealment of material fact, or use of a writing or document knowing the same to contain a false, fictitious, or fraudulent statement or entry, is a violation of the law punishable by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 1001). Note that it is your responsibility to ensure the academic workload met your school’s definition of full-time:

_________________________________________ ______________________________________________

SIGNATURE/DATE EMAIL ADDRESS / PHONE NUMBER

If you did not attend the school for the period as identified above or dropped below a full time status as you previously declared, or if you have married, it is your responsibility to contact DFAS immediately and explain in your own words what happened between the time that you declared an intent to attend the above school and today. You may contact DFAS by phone at 800-321-1080, by fax at 800-982-8459 or by mail to U.S. Military Annuitant Pay 8899 E 56^th Street Indianapolis, IN 46249-1300. Since you have already received annuity payments based on your previous declaration of an intent to attend school on a full time basis as reflected above, you may be responsible to return those payments, for periods that you did not attend school on a full time basis, or for the period in which your marital status changed from single to married.

THIS DOCUMENT MUST ACCOMPANY DD FORM 2788 (If you intend to continue school full time in the future).