10-2553

Certificate of Residency

Agency
VA
Revision
April 2019
Fillable fields
7
Pages
1
Official source
VA form page
Checked
October 20, 2026
Fill 10-2553 online
Page 1 of form 10-2553

VA Form 10-2553: Certificate of Residency

VA Form 10-2553 is a Veterans Health Administration (VHA) Certificate of Residency. It is a one-page certificate template that reads "Certificate of Residency, Presented to", followed by fields for the recipient's name, a description of the recipient's residency, optional text, an optional city, state and date, and the name and title of the official signing the certificate.

The PDF prints no instructions, questions or mailing address. VA's forms feed lists VHA as the administration responsible for it, and VA's form page offers only the downloadable PDF.

You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 10-2553: Certificate of Residency, as printed by VA

What's on VA Form 10-2553

Heading

The printed title Certificate of Residency and the words Presented to.

Recipient and residency

A field to type the name of the recipient and a field to type a description of the recipient's residency.

Optional text, place and date

An optional text field, an optional city and state field and an optional month, date and year field.

Signing official

Fields for the name and the title of the official signing the certificate.

How to fill out VA Form 10-2553

  1. 1

    Type the recipient's name

    Enter it in the field under Presented to.

  2. 2

    Describe the residency

    The field's label says to type a description of the recipient's residency.

  3. 3

    Add the optional details

    Fill in optional text, the city and state, and the month, date and year, or leave them blank.

  4. 4

    Enter the signing official

    Type the name and title of the official signing the certificate, then download or print it.

Why fill Form 10-2553 on indox

You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.

  • Fill the form right in your browser, no software to install
  • Free to fill and free to download, with no account
  • The official blank straight from the VA, not a copy someone retyped
  • Works on a phone, tablet or computer

Using the certificate

No filing address

The PDF prints no mailing address or submission instructions. It is a certificate presented to the recipient.

Online version

VA's form page offers the downloadable PDF only, and VA's forms feed lists no online tool for this form.

Edition

The footer reads VHA FORM 10-2553, APR 2019. VA's form page lists a form revision date of April 2019.

Related forms

Who uses VA Form 10-2553?

  • Issued by VHA

    VA's forms feed lists the Veterans Health Administration as the administration for this form, and the footer reads VHA FORM 10-2553.

  • The signing official

    The PDF has fields for the name and the title of the official signing the certificate.

  • The recipient

    The certificate reads "Presented to" above a field for the recipient's name and a field describing the recipient's residency.

  • Not an application

    The PDF is a certificate template. It asks no questions and prints no instructions or address for sending it anywhere.

The certificate's fields name the recipient and the signing official.

Official sources and the blank

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Questions about Form 10-2553

What is VA Form 10-2553?

It is a one-page VHA Certificate of Residency template, presented to a named recipient and carrying the name and title of the official who signs it.

Which fields are optional?

The PDF's field labels mark the extra text, the city and state, and the month, date and year as optional.

Is there anywhere to send VA Form 10-2553?

No. The PDF prints no mailing address or submission instructions.

Can VA Form 10-2553 be completed online on VA.gov?

VA's form page offers the downloadable PDF only, and VA's forms feed lists no online tool. The PDF can be filled out free in your browser on this page.