VA Form 21-4170
Statement of Marital Relationship (Witness)
A witness with personal knowledge of the couple's informal marriage provides their independent corroboration.
- Who fills it
- representative
- Journey phase
- Keeping Your Award Current
- Estimated time
- 15-20 minutes for the witness.
- When to file
- With VA Form 21-3288.
Official VA form page: https://www.vba.va.gov/pubs/forms/
Gather before you start
- ▸Witness name, address, relationship to the couple
- ▸How the witness knows the couple
- ▸Specific facts the witness has observed about the marital relationship
Attach with the form
Section I - Witness Identification
Blocks 1-4Witness name, address, phone, relationship to couplePII
The witness providing corroboration. Strong witnesses include: long-time neighbors, family members, coworkers, or anyone who has observed the couple over time.
e.g., Thomas Brown, neighbor, 458 Oak Ave, Phoenix AZ; has known couple since 2015.
Common mistakes
- ×Witnesses with no direct knowledge of the relationship providing a statement - VA gives much more weight to witnesses who can describe specific facts they observed.
Section II - Witness Statement
Blocks 5-8What the witness personally observed about the marital relationship
The witness describes specific facts they have personally observed: how long they have known the couple, that the couple lives together as a married couple, that they introduce themselves as husband and wife, any specific observations confirming the marital relationship.
e.g., I have known John Smith and Jane Smith as neighbors since June 2015. They live together at the same address, introduce themselves to me as husband and wife, and I have observed them attending family functions together as a married couple over the past 10 years.
Common mistakes
- ×Vague statements ("they seem married") without specific factual observations.
- ×Witnesses simply stating "they told me they were married" rather than what they personally observed.
Authority
- 38 CFR 3.50 - Defines spouse for VA compensation/pension purposes; covers ceremonial, common-law, and same-sex marriages.
Section III - Witness Certification
Blocks 9-10Witness signature and date
The witness signs and dates under penalty of perjury.
(witness signature/date)
Common mistakes
- ×Veteran signing instead of the witness - the witness must sign this form.
Statutory and regulatory authority
- 38 CFR 3.50 - Defines spouse for VA compensation/pension purposes; covers ceremonial, common-law, and same-sex marriages.