(If so, we will ask you for the dates of service and whether he or she ever received a pension from a military or Federal civilian agency.) Whether the worker was in the active military service before 1968 or ever worked for the railroad industry.(If "Yes," we will also ask you for the date he or she became unable to work.) Whether the worker was unable to work because of illnesses, injuries or conditions at any time during the 14 months before his or her death.The State or foreign country of the worker's fixed permanent residence at the time of death. The worker's date of death and the place of death.
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